{"hospital_name":"Franklin County Memorial Hospital","standard_charge_information":[{"description":"Ilumya Ml 100mg","code_information":[{"code":"3000210","type":"CDM"},{"code":"636","type":"RC"},{"code":"47335017795","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18433,"maximum":21187,"gross_charge":22302,"discounted_cash":20072,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19403},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21187},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21187},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18433},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18433}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tnkase Pr 50mg/vial","code_information":[{"code":"3000451","type":"CDM"},{"code":"636","type":"RC"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11902,"maximum":13680,"gross_charge":14400,"discounted_cash":12960,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12528},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13680},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13680},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11902},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11902},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11902}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Neulasta Inj 6 Mg","code_information":[{"code":"3000286","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10413,"maximum":11969,"gross_charge":12599,"discounted_cash":11339,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10961},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11969},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11969},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10413},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10413},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10413}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Dupixent 300mg/2ml","code_information":[{"code":"3000156","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":6023,"maximum":6923,"gross_charge":7287,"discounted_cash":6558,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6340},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6923},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6923},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6023}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cta Head/neck W & W/o Contrast","code_information":[{"code":"5230085","type":"CDM"},{"code":"350","type":"RC"},{"code":"70471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5381,"maximum":6185,"gross_charge":6510,"discounted_cash":5859,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5664},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6185},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6185},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5381},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5381},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5381}]}]},{"description":"Cta Abdomen/pelvis W & W/o Contras","code_information":[{"code":"5230043","type":"CDM"},{"code":"350","type":"RC"},{"code":"74174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":882,"maximum":5450,"gross_charge":5737,"discounted_cash":5163,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4991},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5450},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5450},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":882},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4742},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4742},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4742}]}]},{"description":"Ct Abd/pelvis W & W/o Contrast","code_information":[{"code":"5230041","type":"CDM"},{"code":"350","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":802,"maximum":5422,"gross_charge":5707,"discounted_cash":5136,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4965},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5422},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5422},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":3199},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":802},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4717},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4717},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4717}]}]},{"description":"Mra Abdomen W & W/o Contrast","code_information":[{"code":"5380050","type":"CDM"},{"code":"610","type":"RC"},{"code":"74185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":878,"maximum":5087,"gross_charge":5355,"discounted_cash":4820,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4659},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5087},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5087},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":878},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4426},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4426},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4426}]}]},{"description":"Ct Renal Artery","code_information":[{"code":"5230044","type":"CDM"},{"code":"350","type":"RC"},{"code":"CP5230044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4056,"maximum":4662,"gross_charge":4907,"discounted_cash":4416,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4269},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4662},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4662},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4056},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4056},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4056}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"5230040","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":711,"maximum":4649,"gross_charge":4894,"discounted_cash":4405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4649},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4649},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2859},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":711},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4045},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4045},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4045}]}]},{"description":"Evenity 210mg / 2.34ml","code_information":[{"code":"3000166","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3928,"maximum":4514,"gross_charge":4752,"discounted_cash":4277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4514},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4514},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3928},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3928},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3928}]}],"drug_information":{"unit":210,"type":"ME"}},{"description":"Mr C-spine W & W/o Contrast","code_information":[{"code":"5380005","type":"CDM"},{"code":"610","type":"RC"},{"code":"72156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":832,"maximum":4336,"gross_charge":4564,"discounted_cash":4108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3971},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4336},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4336},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":832},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3772},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3772},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3772}]}]},{"description":"Polysom 6/>yrs Cpap 4/> P","code_information":[{"code":"5805811","type":"CDM"},{"code":"920","type":"RC"},{"code":"95811","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":943,"maximum":4332,"gross_charge":4560,"discounted_cash":4104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3967},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4332},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4332},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":943},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3769},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3769},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3769}]}]},{"description":"Mr Abdomen W & W/o Contrast","code_information":[{"code":"5380001","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":889,"maximum":4304,"gross_charge":4530,"discounted_cash":4077,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3941},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4304},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4304},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":889},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3744},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3744},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3744}]}]},{"description":"Cta Lower Extremity With Contrast","code_information":[{"code":"5230048","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654,"maximum":4282,"gross_charge":4507,"discounted_cash":4056,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3921},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":654},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3725},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3725},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3725}]}]},{"description":"Nm Lexi Myocardial Perfusion Imaging","code_information":[{"code":"5760006","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1069,"maximum":4277,"gross_charge":4502,"discounted_cash":4052,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3917},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4277},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4277},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2479},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1069},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3721},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3721},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3721}]}]},{"description":"Nm Treadmill Myocardial Perfusion Imag","code_information":[{"code":"5760010","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1069,"maximum":4277,"gross_charge":4502,"discounted_cash":4052,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3917},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4277},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4277},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2479},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1069},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3721},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3721},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3721}]}]},{"description":"Mr T-spine W & W/o Contrast","code_information":[{"code":"5380025","type":"CDM"},{"code":"610","type":"RC"},{"code":"72157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":835,"maximum":4276,"gross_charge":4501,"discounted_cash":4051,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3916},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4276},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":835},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3720}]}]},{"description":"Mr Pelvis W & W/o Contrast","code_information":[{"code":"5380022","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":888,"maximum":4212,"gross_charge":4434,"discounted_cash":3991,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3858},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4212},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4212},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":888},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3665}]}]},{"description":"Mr L-spine W & W/o Contrast","code_information":[{"code":"5380016","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831,"maximum":4176,"gross_charge":4396,"discounted_cash":3956,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3825},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4176},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4176},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":831},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3633},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3633},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3633}]}]},{"description":"Bridionsugammadex 500mg/5ml","code_information":[{"code":"3000455","type":"CDM"},{"code":"250","type":"RC"},{"code":"65425","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":3589,"maximum":4125,"gross_charge":4342,"discounted_cash":3908,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3778},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4125},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3589},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3589},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3589}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ct Abd/pelvis W/o Contrast","code_information":[{"code":"5230039","type":"CDM"},{"code":"350","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":449,"maximum":3984,"gross_charge":4194,"discounted_cash":3775,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3649},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3984},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":3984},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2330},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":449},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3466}]}]},{"description":"MRI Scan","code_information":[{"code":"5380002","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":827,"maximum":3983,"gross_charge":4193,"discounted_cash":3774,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3983},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3983},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":827},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3466}]}]},{"description":"Sleep study","code_information":[{"code":"5805810","type":"CDM"},{"code":"920","type":"RC"},{"code":"95810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":898,"maximum":3907,"gross_charge":4113,"discounted_cash":3702,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3578},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3907},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3907},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":898},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3399},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3399}]}]},{"description":"Mr Chest W & W/o Contrast","code_information":[{"code":"5380007","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1097,"maximum":3859,"gross_charge":4062,"discounted_cash":3656,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3859},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3859},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1097},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3357},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3357},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3357}]}]},{"description":"Mr Orbit/face/neck W & W/o Contrast","code_information":[{"code":"5380019","type":"CDM"},{"code":"610","type":"RC"},{"code":"70543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":882,"maximum":3759,"gross_charge":3957,"discounted_cash":3561,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3443},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3759},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3759},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":882},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3270},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3270}]}]},{"description":"Mr Upper Ext Joint W & W/o Contrast Lt","code_information":[{"code":"5380027","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Upper Ext Joint W & W/o Contrast Rt","code_information":[{"code":"5380029","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Shoulder W & W/o Contrast (Lt)","code_information":[{"code":"5380035","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Shoulder W & W/o Contrast (Rt)","code_information":[{"code":"5380036","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Elbow W & W/o Contrast (Lt)","code_information":[{"code":"5380039","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Elbow W & W/o Contrast (Rt)","code_information":[{"code":"5380040","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Wrist W & W/o Contrast (Rt)","code_information":[{"code":"5380045","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Wrist W & W/o Contrast (Lt)","code_information":[{"code":"5380046","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3259,"maximum":3746,"gross_charge":3943,"discounted_cash":3549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3430},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3746},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3259},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3259}]}]},{"description":"Mr Brain With Contrast","code_information":[{"code":"5380003","type":"CDM"},{"code":"610","type":"RC"},{"code":"70552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":700,"maximum":3716,"gross_charge":3912,"discounted_cash":3521,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3403},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3716},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":700},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3233},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3233},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3233}]}]},{"description":"Mra Brain With Contrast","code_information":[{"code":"5360546","type":"CDM"},{"code":"610","type":"RC"},{"code":"70546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905,"maximum":3713,"gross_charge":3908,"discounted_cash":3517,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3400},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3713},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3713},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3230}]}]},{"description":"Cta Abdomen W & W/o Contrast","code_information":[{"code":"5230045","type":"CDM"},{"code":"350","type":"RC"},{"code":"74175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":646,"maximum":3691,"gross_charge":3885,"discounted_cash":3497,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3380},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3691},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3691},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":646},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3211},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3211},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3211}]}]},{"description":"Mr L-spine With Contrast","code_information":[{"code":"5380017","type":"CDM"},{"code":"610","type":"RC"},{"code":"72149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":704,"maximum":3610,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3306},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":704},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3141}]}]},{"description":"Mr Lower Ext Joint W & W/o Contrast Lt","code_information":[{"code":"5380008","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Lower Ext Joint W & W/o Contrast Rt","code_information":[{"code":"5380010","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Hip W & W/o Contrast (Lt)","code_information":[{"code":"5380062","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Hip W & W/o Contrast (Rt)","code_information":[{"code":"5380063","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Knee W & W/o Contrast (Lt)","code_information":[{"code":"5380070","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Knee W & W/o Contrast (Rt)","code_information":[{"code":"5380072","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Ankle W & W/o Contrast (Lt)","code_information":[{"code":"5380079","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr Ankle W & W/o Contrast (Rt)","code_information":[{"code":"5380080","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3126,"maximum":3593,"gross_charge":3782,"discounted_cash":3404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3593},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3126}]}]},{"description":"Mr T-spine W/o Contrast","code_information":[{"code":"5380026","type":"CDM"},{"code":"610","type":"RC"},{"code":"72146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":493,"maximum":3580,"gross_charge":3768,"discounted_cash":3391,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3278},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3580},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3580},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3114}]}]},{"description":"Mr Brain W/o Contrast","code_information":[{"code":"5380004","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":505,"maximum":3545,"gross_charge":3732,"discounted_cash":3359,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3247},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3545},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3545},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":505},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3084},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3084}]}]},{"description":"Mr Upper Ext No Joint W&w/o Contrast Lt","code_information":[{"code":"5380031","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Upper Ext No Joint W&w/o Contrast Rt","code_information":[{"code":"5380033","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Humerus W & W/o Contrast (Rt)","code_information":[{"code":"5380038","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Forearm W & W/o Contrast (Lt)","code_information":[{"code":"5380041","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Forearm W & W/o Contrast (Rt)","code_information":[{"code":"5380042","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Hand W & W/o Contrast (Lt)","code_information":[{"code":"5380043","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Hand W & W/o Contrast (Rt)","code_information":[{"code":"5380048","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr Humerus W & W/o Contrast (Lt)","code_information":[{"code":"5380053","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":3023,"maximum":3474,"gross_charge":3657,"discounted_cash":3291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3023},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3023}]}]},{"description":"Mr C-spine W/o Contrast","code_information":[{"code":"5380006","type":"CDM"},{"code":"610","type":"RC"},{"code":"72141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":3466,"gross_charge":3648,"discounted_cash":3283,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":492},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3015},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3015},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3015}]}]},{"description":"Mr Lower Ext No Joint W&w/o Contrast Lt","code_information":[{"code":"5380012","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Lower Ext No Joint W&w/o Contrast Rt","code_information":[{"code":"5380014","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Femur W & W/o Contrast (Lt)","code_information":[{"code":"5380066","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Femur W & W/o Contrast (Rt)","code_information":[{"code":"5380067","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Lower Leg W & W/o Contrast (Lt)","code_information":[{"code":"5380075","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Lower Leg W & W/o Contrast (Rt)","code_information":[{"code":"5380076","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Foot W & W/o Contrast (Rt)","code_information":[{"code":"5380083","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Mr Foot W & W/o Contrast (Lt)","code_information":[{"code":"5380084","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2999,"maximum":3448,"gross_charge":3629,"discounted_cash":3266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2999},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2999}]}]},{"description":"Cta Lower Extremity & Aorta With Contras","code_information":[{"code":"5230047","type":"CDM"},{"code":"350","type":"RC"},{"code":"75635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":711,"maximum":3440,"gross_charge":3621,"discounted_cash":3259,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3440},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3440},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":711},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2993},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2993},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2993}]}]},{"description":"Mr Orbit/face/neck W/o Contrast","code_information":[{"code":"5380021","type":"CDM"},{"code":"610","type":"RC"},{"code":"70540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":3405,"gross_charge":3584,"discounted_cash":3226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3405},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3405},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":590},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2962},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2962},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2962}]}]},{"description":"Cta Chest With Contrast","code_information":[{"code":"5230042","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":648,"maximum":3403,"gross_charge":3582,"discounted_cash":3224,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3403},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3403},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":648},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2961},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2961},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2961}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"5380018","type":"CDM"},{"code":"610","type":"RC"},{"code":"72148","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":493,"maximum":3363,"gross_charge":3540,"discounted_cash":3186,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3080},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":3363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2053},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2926},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2926},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2926}]}]},{"description":"Udenyca 6mg","code_information":[{"code":"3000438","type":"CDM"},{"code":"636","type":"RC"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2912,"maximum":3347,"gross_charge":3523,"discounted_cash":3171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3065},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3347},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3347},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2912},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2912},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2912}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Udenyca Subcutaneous Solution 6mg/0.6ml","code_information":[{"code":"3061053","type":"CDM"},{"code":"250","type":"RC"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2912,"maximum":3347,"gross_charge":3523,"discounted_cash":3171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3065},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3347},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3347},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2912},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2912},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2912}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Mr Orbit/face/neck With Contrast","code_information":[{"code":"5380020","type":"CDM"},{"code":"610","type":"RC"},{"code":"70542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":3322,"gross_charge":3497,"discounted_cash":3147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3042},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3322},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3322},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2890},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2890},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2890}]}]},{"description":"Repair Of Hammertoe","code_information":[{"code":"2210028","type":"CDM"},{"code":"360","type":"RC"},{"code":"28285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":865,"maximum":3278,"gross_charge":3450,"discounted_cash":3105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3002},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3278},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3278},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":865},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2851}]}]},{"description":"Ct L-spine W & W/o Contrast","code_information":[{"code":"5230035","type":"CDM"},{"code":"350","type":"RC"},{"code":"72133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584,"maximum":3240,"gross_charge":3410,"discounted_cash":3069,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2967},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":584},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2818},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2818},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2818}]}]},{"description":"Mr Pelvis W/o Contrast","code_information":[{"code":"5380023","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":602,"maximum":3233,"gross_charge":3403,"discounted_cash":3063,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2961},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3233},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3233},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2813},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2813},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2813}]}]},{"description":"Prolia 60mg/ml Inj","code_information":[{"code":"3000335","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2784,"maximum":3200,"gross_charge":3368,"discounted_cash":3031,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2930},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3200},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2784}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ct Abdomen W & W/o Contrast","code_information":[{"code":"5230034","type":"CDM"},{"code":"350","type":"RC"},{"code":"74170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":599,"maximum":3180,"gross_charge":3347,"discounted_cash":3012,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2912},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3180},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3180},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":599},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2766},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2766},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2766}]}]},{"description":"Ct L-spine With Contrast","code_information":[{"code":"5230022","type":"CDM"},{"code":"350","type":"RC"},{"code":"72132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":506,"maximum":3096,"gross_charge":3259,"discounted_cash":2933,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2835},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":506},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2694},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2694},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2694}]}]},{"description":"Ct Pelvis W & W/o Contrast","code_information":[{"code":"5230025","type":"CDM"},{"code":"350","type":"RC"},{"code":"72194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":3091,"gross_charge":3254,"discounted_cash":2929,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2831},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3091},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3091},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":578},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2689},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2689},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2689}]}]},{"description":"Ct Chest W & W/o Contrast","code_information":[{"code":"5230015","type":"CDM"},{"code":"350","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":3089,"gross_charge":3252,"discounted_cash":2927,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2829},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3089},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3089},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":519},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2688}]}]},{"description":"Cta Head W & W/o Contrast","code_information":[{"code":"5230046","type":"CDM"},{"code":"350","type":"RC"},{"code":"70496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":3081,"gross_charge":3243,"discounted_cash":2919,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2821},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3081},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3081},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":640},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2680},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2680},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2680}]}]},{"description":"Cta Neck W & W/o Contrast","code_information":[{"code":"5230106","type":"CDM"},{"code":"350","type":"RC"},{"code":"70498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":3080,"gross_charge":3242,"discounted_cash":2918,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2821},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3080},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3080},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":640},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2680},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2680},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2680}]}]},{"description":"Ct Upper Ext W & W/o Contrast (Rt)","code_information":[{"code":"5230028","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Elbow W & W/o Contrast (Rt)","code_information":[{"code":"5230067","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Forearm W & W/o Contrast (Rt)","code_information":[{"code":"5230070","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Hand W & W/o Contrast (Rt)","code_information":[{"code":"5230073","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Humerus W & W/o Contrast (Rt)","code_information":[{"code":"5230076","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Shoulder W & W/o Contrast (Rt)","code_information":[{"code":"5230079","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Wrist W & W/o Contrast (Rt)","code_information":[{"code":"5230082","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Upper Ext W & W/o Contrast (Lt)","code_information":[{"code":"5230103","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Elbow W & W/o Contrast (Lt)","code_information":[{"code":"5230167","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Forearm W & W/o Contrast (Lt)","code_information":[{"code":"5230170","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Hand W & W/o Contrast (Lt)","code_information":[{"code":"5230173","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Humerus W & W/o Contrast (Lt)","code_information":[{"code":"5230176","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Shoulder W & W/o Contrast (Lt)","code_information":[{"code":"5230179","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Ct Wrist W & W/o Contrast (Lt)","code_information":[{"code":"5230182","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2665,"maximum":3063,"gross_charge":3224,"discounted_cash":2902,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2665},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2665}]}]},{"description":"Vivitrol (Naltrexone) 380mg","code_information":[{"code":"3000453","type":"CDM"},{"code":"636","type":"RC"},{"code":"65757030001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2584,"maximum":2970,"gross_charge":3126,"discounted_cash":2813,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2720},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2970},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2970},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2584},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2584},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2584}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Ct Lower Ext W & W/o C (Rt)","code_information":[{"code":"5230031","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Ankle W & W/o Contrast (Rt)","code_information":[{"code":"5230052","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Femur W & W/o Contrast (Rt)","code_information":[{"code":"5230055","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Foot W & W/o Contrast (Rt)","code_information":[{"code":"5230058","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Knee W & W/o Contrast (Rt)","code_information":[{"code":"5230061","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Lower Leg W & W/o Contrast (Rt)","code_information":[{"code":"5230064","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Hip W & W/o Contrast (Rt)","code_information":[{"code":"5230083","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Hip W & W/o Contrast (Lt)","code_information":[{"code":"5230084","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Lower Ext W & W/o Contrast (Lt)","code_information":[{"code":"5230100","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Ankle W & W/o Contrast (Lt)","code_information":[{"code":"5230152","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Femur W & W/o Contrast (Lt)","code_information":[{"code":"5230155","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Foot W & W/o Contrast (Lt)","code_information":[{"code":"5230158","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Knee W & W/o Contrast (Lt)","code_information":[{"code":"5230161","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct Lower Leg W & W/o Contrast (Lt)","code_information":[{"code":"5230164","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2551,"maximum":2932,"gross_charge":3086,"discounted_cash":2777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2932},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2551}]}]},{"description":"Ct C-spine With Contrast","code_information":[{"code":"5230017","type":"CDM"},{"code":"350","type":"RC"},{"code":"72126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":506,"maximum":2900,"gross_charge":3053,"discounted_cash":2748,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2656},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2900},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2900},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":506},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2523},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2523},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2523}]}]},{"description":"Colonoscopy With Hot Forceps","code_information":[{"code":"2210011","type":"CDM"},{"code":"750","type":"RC"},{"code":"45384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":2880,"gross_charge":3032,"discounted_cash":2729,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2638},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":519},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2506},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2506},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2506}]}]},{"description":"Nm Heart Image (3d) Single","code_information":[{"code":"5760004","type":"CDM"},{"code":"341","type":"RC"},{"code":"78451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":769,"maximum":2858,"gross_charge":3008,"discounted_cash":2707,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2617},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2858},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2858},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":769},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2486},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2486},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2486}]}]},{"description":"Ct Soft Tissue Neck W & W/o Contrast","code_information":[{"code":"5230012","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":545,"maximum":2851,"gross_charge":3001,"discounted_cash":2701,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2611},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":545},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2480}]}]},{"description":"Mr Lower Ext No Joint W/o Contrast Lt","code_information":[{"code":"5380013","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Lower Ext No Joint W/o Contrast Rt","code_information":[{"code":"5380015","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Femur W/o Contrast (Lt)","code_information":[{"code":"5380068","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Femur W/o Contrast (Rt)","code_information":[{"code":"5380069","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Lower Leg W/o Contrast (Lt)","code_information":[{"code":"5380077","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Lower Leg W/o Contrast (Rt)","code_information":[{"code":"5380078","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Foot W/o Contrast (Lt)","code_information":[{"code":"5380085","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Foot W/o Contrast (Rt)","code_information":[{"code":"5380086","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2408,"maximum":2768,"gross_charge":2914,"discounted_cash":2623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2768},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2408},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2408}]}]},{"description":"Mr Upper Ext No Joint W/o Contrast Lt","code_information":[{"code":"5380032","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Upper Ext No Joint W/o Contrast Rt","code_information":[{"code":"5380034","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Hand W/o Contrast (Lt)","code_information":[{"code":"5380044","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Hand W/o Contrast (Rt)","code_information":[{"code":"5380047","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Humerus W/o Contrast (Lt)","code_information":[{"code":"5380051","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Humerus W/o Contrast (Rt)","code_information":[{"code":"5380052","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Forearm W/o Contrast (Rt)","code_information":[{"code":"5380057","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mr Forearm W/o Contrast (Lt)","code_information":[{"code":"5380058","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2363,"maximum":2716,"gross_charge":2859,"discounted_cash":2573,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2716},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Ct Abdomen With Contrast","code_information":[{"code":"5230033","type":"CDM"},{"code":"350","type":"RC"},{"code":"74160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":531,"maximum":2691,"gross_charge":2833,"discounted_cash":2550,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2465},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2691},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2691},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":531},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2341},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2341},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2341}]}]},{"description":"Ct Head W & W/o Contrast","code_information":[{"code":"5230003","type":"CDM"},{"code":"350","type":"RC"},{"code":"70470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":427,"maximum":2689,"gross_charge":2830,"discounted_cash":2547,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2462},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2689},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2689},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1825},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":427},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2339},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2339},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2339}]}]},{"description":"Ct T-spine W & W/o Contrast","code_information":[{"code":"5230020","type":"CDM"},{"code":"350","type":"RC"},{"code":"72130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584,"maximum":2686,"gross_charge":2827,"discounted_cash":2544,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2459},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2686},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2686},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":584},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2337},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2337},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2337}]}]},{"description":"Mr Temporomandibular Joint/s Without Con","code_information":[{"code":"5380024","type":"CDM"},{"code":"610","type":"RC"},{"code":"70336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":670,"maximum":2678,"gross_charge":2819,"discounted_cash":2537,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2453},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2678},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2678},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":670},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2330},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2330},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2330}]}]},{"description":"Dupixent 150mg/ml","code_information":[{"code":"3000154","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"502"}],"standard_charges":[{"setting":"outpatient","modifier_code":["502"],"minimum":2316,"maximum":2662,"gross_charge":2802,"discounted_cash":2522,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2438},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2662},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2662},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2316}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Dupixent 200mg/1.14ml","code_information":[{"code":"3000155","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":2316,"maximum":2662,"gross_charge":2802,"discounted_cash":2522,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2438},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2662},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2662},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2316}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"5230024","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":520,"maximum":2661,"gross_charge":2801,"discounted_cash":2521,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2661},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2661},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":520},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2315},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2315},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2315}]}]},{"description":"Ct Chest With Contrast","code_information":[{"code":"5230014","type":"CDM"},{"code":"350","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438,"maximum":2650,"gross_charge":2789,"discounted_cash":2510,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2426},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2650},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2650},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1551},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2305},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2305},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2305}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380009","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380011","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380064","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380065","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380071","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380074","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380081","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"5380082","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2264,"maximum":2602,"gross_charge":2739,"discounted_cash":2465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2602},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2264}]}]},{"description":"Ct Orbits W & W/o Contrast","code_information":[{"code":"5230006","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":605,"maximum":2594,"gross_charge":2731,"discounted_cash":2458,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2376},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":605},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2257}]}]},{"description":"Ct Posterior Fossa W & W/o Contrast","code_information":[{"code":"5240006","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":605,"maximum":2594,"gross_charge":2731,"discounted_cash":2458,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2376},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":605},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2257}]}]},{"description":"Ct Ear W & W/o Contrast","code_information":[{"code":"5250006","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":605,"maximum":2594,"gross_charge":2731,"discounted_cash":2458,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2376},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":605},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2257}]}]},{"description":"Mr Upper Ext Joint W/o Contrast Lt","code_information":[{"code":"5380028","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Upper Ext Joint W/o Contrast Rt","code_information":[{"code":"5380030","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Shoulder W/o Contrast (Lt)","code_information":[{"code":"5380049","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Elbow W/o Contrast (Rt)","code_information":[{"code":"5380055","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Elbow W/o Contrast (Lt)","code_information":[{"code":"5380056","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Shoulder W/o Contrast (Rt)","code_information":[{"code":"5380059","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Wrist W/o Contrast (Lt)","code_information":[{"code":"5380060","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Mr Wrist W/o Contrast (Rt)","code_information":[{"code":"5380061","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2256,"maximum":2594,"gross_charge":2730,"discounted_cash":2457,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2594},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2256}]}]},{"description":"Ct Maxllofacial W & W/o Contrast","code_information":[{"code":"5230009","type":"CDM"},{"code":"350","type":"RC"},{"code":"70488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":454,"maximum":2569,"gross_charge":2704,"discounted_cash":2434,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2352},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2569},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2569},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":454},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2235},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2235},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2235}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"CP17730782582535641","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584,"maximum":2545,"gross_charge":2679,"discounted_cash":2411,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":584},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2214}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"2210008","type":"CDM"},{"code":"750","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584,"maximum":2545,"gross_charge":2679,"discounted_cash":2411,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2545},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":584},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2214}]}]},{"description":"Ct T-spine With Contrast","code_information":[{"code":"5230019","type":"CDM"},{"code":"350","type":"RC"},{"code":"72129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":509,"maximum":2516,"gross_charge":2648,"discounted_cash":2383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2304},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2516},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2516},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":509},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2189},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2189},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2189}]}]},{"description":"Ct Orbits With Contrast","code_information":[{"code":"5230005","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":2510,"gross_charge":2642,"discounted_cash":2378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2184}]}]},{"description":"Ct Posterior Fossa With Contrast","code_information":[{"code":"5240005","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":2510,"gross_charge":2642,"discounted_cash":2378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2184}]}]},{"description":"Ct Ear With Contrast","code_information":[{"code":"5250005","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":2510,"gross_charge":2642,"discounted_cash":2378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":598},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2184}]}]},{"description":"Ct Soft Tissue Neck With Contrast","code_information":[{"code":"5230011","type":"CDM"},{"code":"350","type":"RC"},{"code":"70491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":452,"maximum":2495,"gross_charge":2626,"discounted_cash":2363,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2285},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2495},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2495},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":452},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2170}]}]},{"description":"Ct C-spine W/o Contrast","code_information":[{"code":"5230016","type":"CDM"},{"code":"350","type":"RC"},{"code":"72125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":367,"maximum":2473,"gross_charge":2603,"discounted_cash":2343,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2473},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2473},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":367},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2151}]}]},{"description":"Ct T-spine W/o Contrast","code_information":[{"code":"5230018","type":"CDM"},{"code":"350","type":"RC"},{"code":"72128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":2457,"gross_charge":2586,"discounted_cash":2327,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2137},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2137}]}]},{"description":"Ct L-spine W/o Contrast","code_information":[{"code":"5230021","type":"CDM"},{"code":"350","type":"RC"},{"code":"72131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":2450,"gross_charge":2579,"discounted_cash":2321,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2450},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2450},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2132},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2132}]}]},{"description":"Injectafer 750mg/15ml","code_information":[{"code":"3060742","type":"CDM"},{"code":"258","type":"RC"},{"code":"51706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2117,"maximum":2433,"gross_charge":2561,"discounted_cash":2305,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2228},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2433},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2433},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2117}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ct Lower Ext With Contrast (Rt)","code_information":[{"code":"5230030","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Hip With Contrast (Rt)","code_information":[{"code":"5230038","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Hip With Contrast (Lt)","code_information":[{"code":"5230049","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Ankle With Contrast (Rt)","code_information":[{"code":"5230051","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Femur With Contrast (Rt)","code_information":[{"code":"5230054","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Foot With Contrast (Rt)","code_information":[{"code":"5230057","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Knee With Contrast (Rt)","code_information":[{"code":"5230060","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Lower Leg With Contrast (Rt)","code_information":[{"code":"5230063","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Lower Ext With Contrast (Lt)","code_information":[{"code":"5230101","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Ankle With Contrast (Lt)","code_information":[{"code":"5230151","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Femur With Contrast (Lt)","code_information":[{"code":"5230154","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Foot With Contrast (Lt)","code_information":[{"code":"5230157","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Knee With Contrast (Lt)","code_information":[{"code":"5230160","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Ct Lower Leg With Contrast (Lt)","code_information":[{"code":"5230163","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2103,"maximum":2418,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2103}]}]},{"description":"Fulphila 6mg","code_information":[{"code":"3000183","type":"CDM"},{"code":"636","type":"RC"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2094,"maximum":2406,"gross_charge":2533,"discounted_cash":2280,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2204},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2406},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2406},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2094},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2094},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2094}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Ct Chest W/o Contrast","code_information":[{"code":"5230013","type":"CDM"},{"code":"350","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":354,"maximum":2376,"gross_charge":2501,"discounted_cash":2251,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2376},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2376},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":354},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2067},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2067},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2067}]}]},{"description":"Ct Upper Ext With Contrast (Rt)","code_information":[{"code":"5230026","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Upper Ext With Contrast (Rt)","code_information":[{"code":"5230027","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Elbow With Contrast (Rt)","code_information":[{"code":"5230066","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Forearm With Contrast (Rt)","code_information":[{"code":"5230069","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Hand With Contrast (Rt)","code_information":[{"code":"5230072","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Humerus With Contrast (Rt)","code_information":[{"code":"5230075","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Shoulder With Contrast (Rt)","code_information":[{"code":"5230078","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Wrist With Contrast (Rt)","code_information":[{"code":"5230081","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Upper Ext With Contrast (Lt)","code_information":[{"code":"5230104","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Elbow With Contrast (Lt)","code_information":[{"code":"5230166","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Forearm With Contrast (Lt)","code_information":[{"code":"5230169","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Hand With Contrast (Lt)","code_information":[{"code":"5230172","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Humerus With Contrast (Lt)","code_information":[{"code":"5230175","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Shoulder With Contrast (Lt)","code_information":[{"code":"5230178","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Wrist With Contrast (Lt)","code_information":[{"code":"5230181","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":2060,"maximum":2368,"gross_charge":2493,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2060},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2060}]}]},{"description":"Ct Head With Contrast","code_information":[{"code":"5230002","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":2348,"gross_charge":2472,"discounted_cash":2225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2348},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2348},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2043}]}]},{"description":"Ct Pelvis W/o Contrast","code_information":[{"code":"5230023","type":"CDM"},{"code":"350","type":"RC"},{"code":"72192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":2336,"gross_charge":2459,"discounted_cash":2213,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2336},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2336},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2032},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2032}]}]},{"description":"Ct Abdomen W/o Contrast","code_information":[{"code":"5230032","type":"CDM"},{"code":"350","type":"RC"},{"code":"74150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":335,"maximum":2318,"gross_charge":2440,"discounted_cash":2196,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2318},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2318},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2017},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2017},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2017}]}]},{"description":"Ct Maxillofacial With Contrast","code_information":[{"code":"5230008","type":"CDM"},{"code":"350","type":"RC"},{"code":"70487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":373,"maximum":2289,"gross_charge":2409,"discounted_cash":2168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2096},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2289},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2289},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":373},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1991},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1991},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1991}]}]},{"description":"Ct Orbits W/o Contrast","code_information":[{"code":"5230004","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":393,"maximum":2265,"gross_charge":2384,"discounted_cash":2146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2074},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":393},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1970}]}]},{"description":"Ct Posterior Fossa W/o Contrast","code_information":[{"code":"5240004","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":393,"maximum":2265,"gross_charge":2384,"discounted_cash":2146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2074},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":393},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1970}]}]},{"description":"Ct Ear W/o Contrast","code_information":[{"code":"5250004","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":393,"maximum":2265,"gross_charge":2384,"discounted_cash":2146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2074},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":393},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1970},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1970}]}]},{"description":"Us Echo 2d Complete","code_information":[{"code":"6693306","type":"CDM"},{"code":"480","type":"RC"},{"code":"93306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":385,"maximum":2229,"gross_charge":2346,"discounted_cash":2111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2041},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2229},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2229},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1939},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1939},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1939}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17730782582532610","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":317,"maximum":2210,"gross_charge":2326,"discounted_cash":2093,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2024},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2210},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2210},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":317},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1922}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"2210013","type":"CDM"},{"code":"750","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":317,"maximum":2210,"gross_charge":2326,"discounted_cash":2093,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2024},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2210},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2210},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":317},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1922}]}]},{"description":"Nm Bone Imaging 3 Phase","code_information":[{"code":"5760002","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":783,"maximum":2200,"gross_charge":2316,"discounted_cash":2084,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2015},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":783},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1914},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1914},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1914}]}]},{"description":"Ct Lower Ext W/o Contrast (Rt)","code_information":[{"code":"5230029","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Hip W/o Contrast (Rt)","code_information":[{"code":"5230036","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Hip W/o Contrast (Lt)","code_information":[{"code":"5230037","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Ankle W/o Contrast (Rt)","code_information":[{"code":"5230050","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Femur W/o Contrast (Rt)","code_information":[{"code":"5230053","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Foot W/o Contrast (Rt)","code_information":[{"code":"5230056","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Knee W/o Contrast (Rt)","code_information":[{"code":"5230059","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Lower Leg W/o Contrast (Rt)","code_information":[{"code":"5230062","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Lower Ext W/o Contrast (Lt)","code_information":[{"code":"5230102","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Ankle W/o Contrast (Lt)","code_information":[{"code":"5230150","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Femur W/o Contrast (Lt)","code_information":[{"code":"5230153","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Foot W/o Contrast (Lt)","code_information":[{"code":"5230156","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Knee W/o Contrast (Lt)","code_information":[{"code":"5230159","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Ct Lower Leg W/o Contrast (Lt)","code_information":[{"code":"5230162","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1913,"maximum":2198,"gross_charge":2314,"discounted_cash":2083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}]},{"description":"Reclast Inj 5mg/100ml","code_information":[{"code":"3000346","type":"CDM"},{"code":"636","type":"RC"},{"code":"66758015546","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1893,"maximum":2176,"gross_charge":2290,"discounted_cash":2061,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1992},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1893},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1893},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1893}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17730782582535469","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":2160,"gross_charge":2274,"discounted_cash":2047,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1879}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"2210012","type":"CDM"},{"code":"750","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":2160,"gross_charge":2274,"discounted_cash":2047,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1879}]}]},{"description":"Ct Soft Tissue Neck W/o Contrast","code_information":[{"code":"5230010","type":"CDM"},{"code":"350","type":"RC"},{"code":"70490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":2159,"gross_charge":2273,"discounted_cash":2046,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1978},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2159},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2159},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1879},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1879}]}]},{"description":"Colonoscopy Medicare Low","code_information":[{"code":"2210007","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":289,"maximum":2158,"gross_charge":2272,"discounted_cash":2045,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1977},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2158},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2158},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":289},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1878},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1878},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1878}]}]},{"description":"Colonoscopy Medicare High","code_information":[{"code":"2210006","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":2123,"gross_charge":2235,"discounted_cash":2012,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2123},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2123},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1847},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1847},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1847}]}]},{"description":"Ct Elbow W/o Contrast (Rt)","code_information":[{"code":"5230065","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Forearm W/o Contrast (Rt)","code_information":[{"code":"5230068","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Hand W/o Contrast (Rt)","code_information":[{"code":"5230071","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Humerus W/o Contrast (Rt)","code_information":[{"code":"5230074","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Shoulder W/o Contrast (Rt)","code_information":[{"code":"5230077","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Wrist W/o Contrast (Rt)","code_information":[{"code":"5230080","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Upper Ext W/o Contrast (Lt)","code_information":[{"code":"5230105","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Elbow W/o Contrast (Lt)","code_information":[{"code":"5230165","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Forearm W/o Contrast (Lt)","code_information":[{"code":"5230168","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Hand W/o Contrast (Lt)","code_information":[{"code":"5230171","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Humerus W/o Contrast (Lt)","code_information":[{"code":"5230174","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Shoulder W/o Contrast (Lt)","code_information":[{"code":"5230177","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Wrist W/o Contrast (Lt)","code_information":[{"code":"5230180","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1841,"maximum":2116,"gross_charge":2227,"discounted_cash":2004,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Nm Muga (Gated Blood Pool)","code_information":[{"code":"5760007","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":2107,"gross_charge":2218,"discounted_cash":1996,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1930},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2107},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2107},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":519},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1833},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1833},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1833}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"CP17730782582538597","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":2103,"gross_charge":2214,"discounted_cash":1993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1926},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1830}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"2210009","type":"CDM"},{"code":"750","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":2103,"gross_charge":2214,"discounted_cash":1993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1926},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2103},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1830},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1830}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"CP17730782582538083","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":423,"maximum":2091,"gross_charge":2201,"discounted_cash":1981,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1915},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2091},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2091},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":423},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1819},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1819},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1819}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"2210005","type":"CDM"},{"code":"750","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":423,"maximum":2091,"gross_charge":2201,"discounted_cash":1981,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1915},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2091},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2091},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":423},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1819},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1819},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1819}]}]},{"description":"Mra Brain W/o Contrast","code_information":[{"code":"5360544","type":"CDM"},{"code":"611","type":"RC"},{"code":"70554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":978,"maximum":2075,"gross_charge":2184,"discounted_cash":1966,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1900},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2075},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2075},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":978},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1805},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1805},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1805}]}]},{"description":"CT scan","code_information":[{"code":"5230001","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":2065,"gross_charge":2174,"discounted_cash":1957,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2065},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2065},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1440},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":258},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1797},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1797},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1797}]}]},{"description":"Groshong 9 5fr Dual Lumen Cv Cath","code_information":[{"code":"2589729","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589729","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1777,"maximum":2043,"gross_charge":2150,"discounted_cash":1935,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1871},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1777},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1777},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1777}]}]},{"description":"Ct Chest W/o Ldct Lung Cancer Screening","code_information":[{"code":"5230297","type":"CDM"},{"code":"350","type":"RC"},{"code":"71271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":1995,"gross_charge":2100,"discounted_cash":1890,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":306},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1736}]}]},{"description":"Critical Care Addl 30 Min","code_information":[{"code":"1090011","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":1956,"gross_charge":2059,"discounted_cash":1853,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1791},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1956},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1956},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1702},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1702},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1702}]}]},{"description":"Nm Nuclear Bone Scan Multiple Area","code_information":[{"code":"5760001","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":634,"maximum":1937,"gross_charge":2039,"discounted_cash":1835,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1774},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":634},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1685},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1685},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1685}]}]},{"description":"Nm Hida","code_information":[{"code":"5760005","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":904,"maximum":1937,"gross_charge":2039,"discounted_cash":1835,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1774},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":904},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1685},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1685},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1685}]}]},{"description":"Ct Maxillofacial W/o Contrast","code_information":[{"code":"5230007","type":"CDM"},{"code":"350","type":"RC"},{"code":"70486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":1921,"gross_charge":2022,"discounted_cash":1820,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1759},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1921},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1921},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1671},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1671},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1671}]}]},{"description":"Nm Nuclear Bone Total Body","code_information":[{"code":"5760008","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":684,"maximum":1870,"gross_charge":1968,"discounted_cash":1771,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1712},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":684},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1627},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1627},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1627}]}]},{"description":"Gastrointestinal Pathogen Panel, Feces","code_information":[{"code":"4000480","type":"CDM"},{"code":"300","type":"RC"},{"code":"87507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":849,"maximum":1796,"gross_charge":1890,"discounted_cash":1701,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1644},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1796},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1796},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":849},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1562},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1562},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1562}]}]},{"description":"Colonoscopy W/ink Tattoo","code_information":[{"code":"2210010","type":"CDM"},{"code":"750","type":"RC"},{"code":"45381","type":"CPT","modifier":"51"}],"standard_charges":[{"setting":"outpatient","modifier_code":["51"],"minimum":1551,"maximum":1782,"gross_charge":1876,"discounted_cash":1688,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1782},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1782},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1551},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1551}]}]},{"description":"Er-lev 6-critical Er Visit:1st 30-74 Min","code_information":[{"code":"1090020","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":1740,"gross_charge":1832,"discounted_cash":1649,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1594},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1740},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1740},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":412},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1514},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1514},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1514}]}]},{"description":"Platelets /1unit","code_information":[{"code":"4101009","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1360,"maximum":1564,"gross_charge":1646,"discounted_cash":1481,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1432},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1564},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1564},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1360}]}]},{"description":"Us Carotid Artery Bilateral","code_information":[{"code":"6693880","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":1467,"gross_charge":1544,"discounted_cash":1390,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1343},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1467},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1467},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1276}]}]},{"description":"Closed Tx Of Ankle Disloc","code_information":[{"code":"8027840","type":"CDM"},{"code":"521","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":833,"maximum":1443,"gross_charge":1519,"discounted_cash":1367,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1322},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1443},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1443},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":833},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1255}]}]},{"description":"Emergency Labor & Delivery","code_information":[{"code":"1090013","type":"CDM"},{"code":"450","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239,"maximum":1424,"gross_charge":1499,"discounted_cash":1349,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1304},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1424},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1424},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1379},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1239}]}]},{"description":"Us Venous Duplex Lower Bilateral","code_information":[{"code":"6693970","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":359,"maximum":1377,"gross_charge":1449,"discounted_cash":1304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":359},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1198},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1198}]}]},{"description":"Us Venous Duplex Upper Bilateral","code_information":[{"code":"6693976","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":359,"maximum":1377,"gross_charge":1449,"discounted_cash":1304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":359},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1198},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1198}]}]},{"description":"Treadmill Stress Test","code_information":[{"code":"5760009","type":"CDM"},{"code":"341","type":"RC"},{"code":"93015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":1321,"gross_charge":1391,"discounted_cash":1252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1210},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1150}]}]},{"description":"Er- Level 5high Er Visit","code_information":[{"code":"1090018","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":321,"maximum":1256,"gross_charge":1322,"discounted_cash":1190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1093}]}]},{"description":"Us Arterial Duplex Upper (Rt)","code_information":[{"code":"6693930","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1031,"maximum":1185,"gross_charge":1247,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1031},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1031},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1031}]}]},{"description":"Us Arterial Duplex Upper (Lt)","code_information":[{"code":"6693931","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1031,"maximum":1185,"gross_charge":1247,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1031},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1031},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1031}]}]},{"description":"Us Arterial Duplex Lower Bilateral","code_information":[{"code":"6693925","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":1175,"gross_charge":1237,"discounted_cash":1113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1076},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1175},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1175},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":471},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1022}]}]},{"description":"Us Abdomen Vascular Duplex","code_information":[{"code":"6693975","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":513,"maximum":1170,"gross_charge":1232,"discounted_cash":1109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1072},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":513},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1018},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1018},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1018}]}]},{"description":"Cr Cardiac Stress Test","code_information":[{"code":"6693017","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":1155,"gross_charge":1216,"discounted_cash":1094,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1058},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1155},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1155},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1005},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1005},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1005}]}]},{"description":"Us Arterial Duplex Upper Bilateral","code_information":[{"code":"6693932","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":378,"maximum":1100,"gross_charge":1158,"discounted_cash":1042,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1007},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1100},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1100},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":957},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":957},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":957}]}]},{"description":"Treatment Room 5","code_information":[{"code":"7920005","type":"CDM"},{"code":"761","type":"RC"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":1097,"gross_charge":1155,"discounted_cash":1040,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1005},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1097},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":199},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":955}]}]},{"description":"Us Aorta / Ivc / Iliac Duplex, Complete","code_information":[{"code":"6693978","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":347,"maximum":1053,"gross_charge":1108,"discounted_cash":997,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":964},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1053},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1053},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":916},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":916},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":916}]}]},{"description":"Layer Repr Face >2.6cm-5.0cm","code_information":[{"code":"1090048","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":456,"maximum":1048,"gross_charge":1103,"discounted_cash":993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":456},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":912}]}]},{"description":"Us Venous Duplex Lower (Lt)","code_information":[{"code":"6693971","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":905,"maximum":1040,"gross_charge":1095,"discounted_cash":986,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905}]}]},{"description":"Us Venous Duplex Upper (Lt)","code_information":[{"code":"6693972","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":905,"maximum":1040,"gross_charge":1095,"discounted_cash":986,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905}]}]},{"description":"Us Venous Duplex Lower (Rt)","code_information":[{"code":"6693973","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":905,"maximum":1040,"gross_charge":1095,"discounted_cash":986,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905}]}]},{"description":"Us Venous Duplex Upper (Rt)","code_information":[{"code":"6693974","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":905,"maximum":1040,"gross_charge":1095,"discounted_cash":986,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1040},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":905}]}]},{"description":"Zarxio 300mcg/0.5ml","code_information":[{"code":"3000418","type":"CDM"},{"code":"636","type":"RC"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":904,"maximum":1039,"gross_charge":1094,"discounted_cash":985,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":952},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":904},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":904},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":904}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Gastrointestinal Pathogen Panel","code_information":[{"code":"4000479","type":"CDM"},{"code":"300","type":"RC"},{"code":"87506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":482,"maximum":1037,"gross_charge":1092,"discounted_cash":983,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1037},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1037},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":482},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":903},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":903},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":903}]}]},{"description":"Treatment Of Prosthetic Hip Dislocation","code_information":[{"code":"8027265","type":"CDM"},{"code":"521","type":"RC"},{"code":"27265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":894,"maximum":1028,"gross_charge":1082,"discounted_cash":974,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":895},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":894},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":894},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":894}]}]},{"description":"Tr Bladder Irrigation Simple Lavage","code_information":[{"code":"220011","type":"CDM"},{"code":"761","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":1022,"gross_charge":1076,"discounted_cash":968,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":889}]}]},{"description":"Synvisc/synvisc-one  1 Mg","code_information":[{"code":"8077325","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":1022,"gross_charge":1076,"discounted_cash":968,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":889}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Comp Repair Scalp, Arms, Legs 2.6-7.5cm","code_information":[{"code":"1090064","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":597,"maximum":1013,"gross_charge":1066,"discounted_cash":959,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":927},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1013},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1013},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":597},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":881}]}]},{"description":"Procrit 40,000 Units/ml","code_information":[{"code":"3000334","type":"CDM"},{"code":"636","type":"RC"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":861,"maximum":990,"gross_charge":1042,"discounted_cash":938,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":907},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":861}]}],"drug_information":{"unit":40000,"type":"UN"}},{"description":"Cl-synvisc One Syringe 48 Mg","code_information":[{"code":"3000108","type":"CDM"},{"code":"636","type":"RC"},{"code":"21695031301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":855,"maximum":983,"gross_charge":1035,"discounted_cash":932,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":855}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Cl-synvisc Syringe 16 Mg","code_information":[{"code":"3000109","type":"CDM"},{"code":"636","type":"RC"},{"code":"21695049301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":855,"maximum":983,"gross_charge":1035,"discounted_cash":932,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":855}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Synvisc One/hylan G-f 20 Syr 48mg","code_information":[{"code":"3000366","type":"CDM"},{"code":"636","type":"RC"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":855,"maximum":983,"gross_charge":1035,"discounted_cash":932,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":983},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":855}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Xr Upper Gastrointestinal Tract W/sm Int","code_information":[{"code":"5010102","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":963,"gross_charge":1014,"discounted_cash":913,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":272},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Us Arterial Duplex Lower (Rt)","code_information":[{"code":"6693926","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":831,"maximum":955,"gross_charge":1005,"discounted_cash":905,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":831}]}]},{"description":"Us Arterial Duplex Lower (Lt)","code_information":[{"code":"6693928","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":831,"maximum":955,"gross_charge":1005,"discounted_cash":905,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":831}]}]},{"description":"Semi-private Room","code_information":[{"code":"100010","type":"CDM"},{"code":"120","type":"RC"},{"code":"CP100010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":830,"maximum":954,"gross_charge":1004,"discounted_cash":904,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":830},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":830},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":830}]}]},{"description":"Risperdal 50 Mg Injection","code_information":[{"code":"8072794","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":941,"gross_charge":990,"discounted_cash":891,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":818}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Crcam Monitor >7-15days","code_information":[{"code":"5500010","type":"CDM"},{"code":"731","type":"RC"},{"code":"93246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":812,"maximum":934,"gross_charge":983,"discounted_cash":885,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":812}]}]},{"description":"Blood Transfusion >6 Hours","code_information":[{"code":"240035","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":917,"gross_charge":965,"discounted_cash":869,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":917},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":917},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":798}]}]},{"description":"Cr Arterial Segmental Lower","code_information":[{"code":"6693927","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245,"maximum":915,"gross_charge":963,"discounted_cash":867,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":796}]}]},{"description":"Us Ankle Arm Index W/exercise (Abi)","code_information":[{"code":"6693924","type":"CDM"},{"code":"921","type":"RC"},{"code":"93924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303,"maximum":902,"gross_charge":949,"discounted_cash":854,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":303},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":784}]}]},{"description":"Us Echo 2d Limited","code_information":[{"code":"6693308","type":"CDM"},{"code":"480","type":"RC"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":894,"gross_charge":941,"discounted_cash":847,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":894},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":894},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":778}]}]},{"description":"Xr Urography Intravenous","code_information":[{"code":"5010103","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":892,"gross_charge":939,"discounted_cash":845,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":817},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":892},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":264},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":776}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"5130001","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":890,"gross_charge":937,"discounted_cash":843,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":729},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":729},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":272},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":774},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":538},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":538}]}]},{"description":"Treat Finger Dislocation W/anesthesia","code_information":[{"code":"1090044","type":"CDM"},{"code":"450","type":"RC"},{"code":"26775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":767,"maximum":888,"gross_charge":935,"discounted_cash":842,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":888},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":888},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":767},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":773}]}]},{"description":"Lacer Layered 7.6-12.5cm","code_information":[{"code":"1090070","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":873,"gross_charge":919,"discounted_cash":827,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":463},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":760}]}]},{"description":"Tc99m Sestamibi(cardiolit","code_information":[{"code":"5081019","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":858,"gross_charge":903,"discounted_cash":813,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":858},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":858},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":746}]}]},{"description":"Blood Transfusion Up To 2 Hours","code_information":[{"code":"240032","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":855,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":744}]}]},{"description":"Blood Transfusion Up To 4 Hours","code_information":[{"code":"240033","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":855,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":744}]}]},{"description":"Blood Transfusion Up To 6 Hours","code_information":[{"code":"240034","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":855,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":744}]}]},{"description":"Xr Osseous Survey Axial&appendicular Ske","code_information":[{"code":"5010071","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":854,"gross_charge":899,"discounted_cash":809,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":743}]}]},{"description":"Closed Tx Of Ankle Disloc","code_information":[{"code":"1090062","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":741,"maximum":852,"gross_charge":897,"discounted_cash":807,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":780},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":852},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":852},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":833},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":741}]}]},{"description":"Filgrastim Inj 480 Mcg/1.6 Ml","code_information":[{"code":"3000172","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":733,"maximum":843,"gross_charge":887,"discounted_cash":798,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":772},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":843},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":843},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":733},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":733},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":733}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Fracture Care Distal Fibula","code_information":[{"code":"8027786","type":"CDM"},{"code":"521","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":841,"gross_charge":885,"discounted_cash":797,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":841},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":841},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":633},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":731},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":731},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":731}]}]},{"description":"Excision Malignant Lesion Over 4 Cm","code_information":[{"code":"8011606","type":"CDM"},{"code":"521","type":"RC"},{"code":"11606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":712,"maximum":838,"gross_charge":882,"discounted_cash":794,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":712},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":729}]}]},{"description":"Er- Level 4major Er Visit","code_information":[{"code":"1090017","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":833,"gross_charge":877,"discounted_cash":789,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":763},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":725}]}]},{"description":"Us Pelvis","code_information":[{"code":"5130009","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":244,"maximum":816,"gross_charge":859,"discounted_cash":773,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":747},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":244},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":710},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":493}]}]},{"description":"Us Retroperitoneal (Renal)","code_information":[{"code":"5130011","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":252,"maximum":813,"gross_charge":856,"discounted_cash":770,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":745},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":707},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":492},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":492}]}]},{"description":"Unit 2 Charge","code_information":[{"code":"4101005","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":807,"gross_charge":849,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Unit 3 Charge","code_information":[{"code":"4101006","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":807,"gross_charge":849,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Unit 4 Charge","code_information":[{"code":"4101007","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":807,"gross_charge":849,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Unit 1 Charge","code_information":[{"code":"4101008","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":702,"maximum":807,"gross_charge":849,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":702}]}]},{"description":"Swing Bed","code_information":[{"code":"5800010","type":"CDM"},{"code":"120","type":"RC"},{"code":"CP5800010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":683,"maximum":785,"gross_charge":826,"discounted_cash":743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":785},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":785},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":683},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":683},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":683}]}]},{"description":"Simple Rpr Face/ear/eye/nose 2.5cm-5cm","code_information":[{"code":"1090043","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":777,"gross_charge":818,"discounted_cash":736,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":676}]}]},{"description":"Us Carotid Artery (Rt)","code_information":[{"code":"6693881","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":669,"maximum":769,"gross_charge":809,"discounted_cash":728,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":669}]}]},{"description":"Us Carotid Artery (Lt)","code_information":[{"code":"6693882","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":669,"maximum":769,"gross_charge":809,"discounted_cash":728,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":669}]}]},{"description":"Fract Humeral Shaft-close","code_information":[{"code":"8024500","type":"CDM"},{"code":"521","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":666,"maximum":766,"gross_charge":806,"discounted_cash":725,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":722},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":666}]}]},{"description":"Hospice","code_information":[{"code":"100002","type":"CDM"},{"code":"120","type":"RC"},{"code":"CP100002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":657,"maximum":755,"gross_charge":795,"discounted_cash":716,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":692},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":657}]}]},{"description":"Treatment Room 4","code_information":[{"code":"7920004","type":"CDM"},{"code":"761","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":753,"gross_charge":793,"discounted_cash":714,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":690},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":753},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":655}]}]},{"description":"Negative Pressure Wound Therapy <=50sqcm","code_information":[{"code":"7940068","type":"CDM"},{"code":"761","type":"RC"},{"code":"97607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":738,"gross_charge":777,"discounted_cash":699,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":642}]}]},{"description":"Layer Repr Face <2.5cm","code_information":[{"code":"1090069","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":383,"maximum":728,"gross_charge":766,"discounted_cash":689,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":728},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":728},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"Observ Room Initial","code_information":[{"code":"240001","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":632,"maximum":727,"gross_charge":765,"discounted_cash":689,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":727},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":727},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":632}]}]},{"description":"Fracture Finger","code_information":[{"code":"8026725","type":"CDM"},{"code":"521","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":629,"maximum":723,"gross_charge":761,"discounted_cash":685,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":723},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":723},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":671},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":629}]}]},{"description":"Us Aorta / Ivc / Iliac Duplex, Limited","code_information":[{"code":"6693979","type":"CDM"},{"code":"921","type":"RC"},{"code":"93979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":722,"gross_charge":760,"discounted_cash":684,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":661},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":628}]}]},{"description":"Treat Finger Dislocation W/anesthesia","code_information":[{"code":"8026775","type":"CDM"},{"code":"521","type":"RC"},{"code":"26775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625,"maximum":767,"gross_charge":756,"discounted_cash":680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":658},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":767},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":625}]}]},{"description":"Endotracheal Intubation","code_information":[{"code":"240078","type":"CDM"},{"code":"762","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":321,"maximum":715,"gross_charge":753,"discounted_cash":678,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":622}]}]},{"description":"Endotracheal Intubation","code_information":[{"code":"1090019","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":321,"maximum":715,"gross_charge":753,"discounted_cash":678,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":622}]}]},{"description":"Respite Care Level 2","code_information":[{"code":"100003","type":"CDM"},{"code":"120","type":"RC"},{"code":"CP100003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":620,"maximum":713,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":653},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":620}]}]},{"description":"Laceration Layer Repair 2.6cm-7.5cm","code_information":[{"code":"1090036","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":700,"gross_charge":737,"discounted_cash":663,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":434},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":609}]}]},{"description":"Definity 2ml Perflutren","code_information":[{"code":"5081129","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":594,"maximum":683,"gross_charge":719,"discounted_cash":647,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":683},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":683},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":594}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Us Abdomen Limited","code_information":[{"code":"5130002","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":682,"gross_charge":718,"discounted_cash":646,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":593},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":412},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":412}]}]},{"description":"Xr Small Bowel Series","code_information":[{"code":"5010094","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":681,"gross_charge":717,"discounted_cash":645,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":593}]}]},{"description":"Sp Spirometry Pre-vs Post-bronchodilator","code_information":[{"code":"5090101","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":681,"gross_charge":717,"discounted_cash":645,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":593}]}]},{"description":"Us Scrotum","code_information":[{"code":"5130012","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":680,"gross_charge":716,"discounted_cash":644,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":592},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":411},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":411}]}]},{"description":"Frac Care Distal Radius","code_information":[{"code":"8025600","type":"CDM"},{"code":"521","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":590,"maximum":692,"gross_charge":714,"discounted_cash":643,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":621},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":678},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":678},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":692},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":590}]}]},{"description":"Laceration 7.6-12.5cm","code_information":[{"code":"1090060","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":675,"gross_charge":710,"discounted_cash":639,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":587}]}]},{"description":"Control Nasal Hemorrhage W/cautery Subse","code_information":[{"code":"1090057","type":"CDM"},{"code":"450","type":"RC"},{"code":"30906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":304,"maximum":670,"gross_charge":705,"discounted_cash":635,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":304},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":583}]}]},{"description":"Excision Of Lesion, Cyst, Hand Or Finger","code_information":[{"code":"8096160","type":"CDM"},{"code":"521","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":583,"maximum":740,"gross_charge":705,"discounted_cash":635,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":740},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":583}]}]},{"description":"Xr Osseous Survey Limited (Metastases)","code_information":[{"code":"5010072","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":151,"maximum":666,"gross_charge":701,"discounted_cash":631,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":579}]}]},{"description":"Exc Malignant Face 2.1 To 3.0","code_information":[{"code":"8011643","type":"CDM"},{"code":"521","type":"RC"},{"code":"11643","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":514,"maximum":665,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":514},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":579}]}]},{"description":"Lexiscan Inj","code_information":[{"code":"5081295","type":"CDM"},{"code":"636","type":"RC"},{"code":"46965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":577,"maximum":663,"gross_charge":698,"discounted_cash":628,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":577}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"5130014","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":663,"gross_charge":698,"discounted_cash":628,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":272},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":577},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":401}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"5130015","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":272,"maximum":663,"gross_charge":698,"discounted_cash":628,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":272},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":577},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":401}]}]},{"description":"Xr Esophagus","code_information":[{"code":"5010028","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":662,"gross_charge":697,"discounted_cash":627,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"Closed Finger Dislocation Wo Anesth","code_information":[{"code":"1090008","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":562,"maximum":646,"gross_charge":680,"discounted_cash":612,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":569},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":562}]}]},{"description":"Xr C-spine Minimum 6 Views","code_information":[{"code":"5010017","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":645,"gross_charge":679,"discounted_cash":611,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":561}]}]},{"description":"Us Extremity Complete","code_information":[{"code":"5130006","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":645,"gross_charge":679,"discounted_cash":611,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":561},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":390},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":390}]}]},{"description":"Control Nasal Hemorrhage W/cautery Initi","code_information":[{"code":"1090056","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":236,"maximum":637,"gross_charge":671,"discounted_cash":604,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":555}]}]},{"description":"Cricithyotomy Kit(nu Trach)","code_information":[{"code":"2589730","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589730","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":554,"maximum":637,"gross_charge":670,"discounted_cash":603,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":554}]}]},{"description":"Us Soft Tissue Neck","code_information":[{"code":"5130013","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":630,"gross_charge":663,"discounted_cash":597,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":548},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":381},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":381}]}]},{"description":"Us Thyroid","code_information":[{"code":"5130017","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":630,"gross_charge":663,"discounted_cash":597,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":548},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":381},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":381}]}]},{"description":"Laceration Layer 2.6-7.5c","code_information":[{"code":"8012032","type":"CDM"},{"code":"521","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":434,"maximum":620,"gross_charge":653,"discounted_cash":588,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":434},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540}]}]},{"description":"Excision Malignant Lesion 3cm Plus","code_information":[{"code":"8011623","type":"CDM"},{"code":"521","type":"RC"},{"code":"11623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":613,"gross_charge":645,"discounted_cash":581,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":474},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":533}]}]},{"description":"Orthovisc 30mg/2ml","code_information":[{"code":"3000311","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":532,"maximum":612,"gross_charge":644,"discounted_cash":580,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Fracture Metatarsal","code_information":[{"code":"8028470","type":"CDM"},{"code":"521","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":455,"maximum":600,"gross_charge":632,"discounted_cash":569,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":522}]}]},{"description":"Laceration Face 5.1-7.5 Cm","code_information":[{"code":"1090067","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":599,"gross_charge":630,"discounted_cash":567,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Exc Malignant Lesion 2.1 To 3 Cm","code_information":[{"code":"8011603","type":"CDM"},{"code":"521","type":"RC"},{"code":"11603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438,"maximum":599,"gross_charge":630,"discounted_cash":567,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Xr Hip Bilateral 3 Or 4 Views","code_information":[{"code":"5010046","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":596,"gross_charge":627,"discounted_cash":564,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":518}]}]},{"description":"Us Breast Complete (Lt)","code_information":[{"code":"5130003","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":590,"gross_charge":621,"discounted_cash":559,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":513},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":357}]}]},{"description":"Us Breast Complete (Rt)","code_information":[{"code":"5130019","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":590,"gross_charge":621,"discounted_cash":559,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":513},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":357}]}]},{"description":"Frac Care Metacarpal","code_information":[{"code":"8026600","type":"CDM"},{"code":"521","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":513,"maximum":616,"gross_charge":621,"discounted_cash":559,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":616},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":513}]}]},{"description":"Dressing &/Or Debridement 5-10% Total Bo","code_information":[{"code":"1090053","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":583,"gross_charge":614,"discounted_cash":553,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":507}]}]},{"description":"Excision B9 Skin Arm W/shoulder 3.1-4 Cm","code_information":[{"code":"8011424","type":"CDM"},{"code":"521","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":579,"gross_charge":609,"discounted_cash":548,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":400},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Dressing &/Or Debridement <5% Total Body","code_information":[{"code":"1090052","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":573,"gross_charge":603,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":573},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":573},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":498}]}]},{"description":"Benign Lesion Other 4.0cm","code_information":[{"code":"8011426","type":"CDM"},{"code":"521","type":"RC"},{"code":"11426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":493,"maximum":611,"gross_charge":597,"discounted_cash":537,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":611},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":493}]}]},{"description":"Frac Care Radial Wo Manip","code_information":[{"code":"8025500","type":"CDM"},{"code":"521","type":"RC"},{"code":"25500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":564,"gross_charge":594,"discounted_cash":535,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":556},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":491}]}]},{"description":"Control Nasal Hemorrhage Complex","code_information":[{"code":"1090055","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":561,"gross_charge":591,"discounted_cash":532,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":488}]}]},{"description":"Us Misc (Diagnostic Interventional)","code_information":[{"code":"5130008","type":"CDM"},{"code":"402","type":"RC"},{"code":"76999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339,"maximum":561,"gross_charge":591,"discounted_cash":532,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":488},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":339}]}]},{"description":"Us Chest","code_information":[{"code":"5130005","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":561,"gross_charge":590,"discounted_cash":531,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":488},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":339}]}]},{"description":"Malgnt Lesion Face 1.1-2c","code_information":[{"code":"8011642","type":"CDM"},{"code":"521","type":"RC"},{"code":"11642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":554,"gross_charge":583,"discounted_cash":525,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":412},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":482}]}]},{"description":"Us Extremity Limited","code_information":[{"code":"5130007","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":546,"gross_charge":575,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":475},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":330},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":330}]}]},{"description":"Xr Ribs Bilateral W/chest Minimum 4 View","code_information":[{"code":"5010076","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":545,"gross_charge":574,"discounted_cash":517,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":474}]}]},{"description":"Us Ankle Brachial Index (Abi)","code_information":[{"code":"6693922","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":542,"gross_charge":571,"discounted_cash":514,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":472}]}]},{"description":"Us Arterial Ankle/arm Index (Abi)","code_information":[{"code":"6693923","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":542,"gross_charge":571,"discounted_cash":514,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":472}]}]},{"description":"Large Throat Panel","code_information":[{"code":"4000376","type":"CDM"},{"code":"300","type":"RC"},{"code":"0564U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":469,"maximum":540,"gross_charge":568,"discounted_cash":511,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":469}]}]},{"description":"Large Respiratory Panel (Covid-19)","code_information":[{"code":"4000386","type":"CDM"},{"code":"300","type":"RC"},{"code":"0563U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":469,"maximum":540,"gross_charge":568,"discounted_cash":511,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":469}]}]},{"description":"Neupogen 300 Mcg","code_information":[{"code":"3000287","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513053001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":467,"maximum":537,"gross_charge":565,"discounted_cash":509,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"X-Ray of lower back","code_information":[{"code":"5010065","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":536,"gross_charge":564,"discounted_cash":508,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":466}]}]},{"description":"Xr Abdomen W/chest Minimum 3 Views","code_information":[{"code":"5010004","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":534,"gross_charge":562,"discounted_cash":506,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":464}]}]},{"description":"Rabavert Rabies Vaccine","code_information":[{"code":"8090675","type":"CDM"},{"code":"250","type":"RC"},{"code":"90675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":532,"gross_charge":560,"discounted_cash":504,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":463}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Negative Pressure Wound Therapy >=50cm","code_information":[{"code":"7920007","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":531,"gross_charge":559,"discounted_cash":503,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":462}]}]},{"description":"Laceration Face 5.1 To 7.5 Cm","code_information":[{"code":"8012014","type":"CDM"},{"code":"521","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":529,"gross_charge":557,"discounted_cash":501,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Procrit 20,000 U/ml","code_information":[{"code":"3000333","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":460,"maximum":528,"gross_charge":556,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":460}]}],"drug_information":{"unit":20000,"type":"UN"}},{"description":"I & D Of Abscess; Simple Or Single","code_information":[{"code":"1090049","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":526,"gross_charge":554,"discounted_cash":499,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":458}]}]},{"description":"Removal Fb Complicated","code_information":[{"code":"8010121","type":"CDM"},{"code":"521","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":523,"gross_charge":551,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":415},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Malgnt Lesion Other 1-2cm","code_information":[{"code":"8011622","type":"CDM"},{"code":"521","type":"RC"},{"code":"11622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":383,"maximum":523,"gross_charge":551,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Intermediate Laceration Repair Finger","code_information":[{"code":"8012041","type":"CDM"},{"code":"521","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":335,"maximum":523,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Xr C-spine 4 Or 5 Views","code_information":[{"code":"5010016","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":519,"gross_charge":546,"discounted_cash":491,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"Er- Level 3moderate Er Visit","code_information":[{"code":"1090016","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":517,"gross_charge":544,"discounted_cash":490,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Glucagon Kit [1 Mg]","code_information":[{"code":"3000192","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323058282","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":450,"maximum":517,"gross_charge":544,"discounted_cash":490,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":450}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Crcam Monitor Up To 48 Hr","code_information":[{"code":"5500009","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":516,"gross_charge":543,"discounted_cash":489,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":449},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":449},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":449}]}]},{"description":"Treatment Room 3","code_information":[{"code":"7920003","type":"CDM"},{"code":"761","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":514,"gross_charge":541,"discounted_cash":487,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":447}]}]},{"description":"Malgnt Lesion Other .6-1c","code_information":[{"code":"8011621","type":"CDM"},{"code":"521","type":"RC"},{"code":"11621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":510,"gross_charge":537,"discounted_cash":483,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":336},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":444}]}]},{"description":"Hepatitis B Surface Antibody Quant","code_information":[{"code":"4000244","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":506,"gross_charge":533,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Hepatitis C Ab W/reflx To Hcv Rna Qn Pcr","code_information":[{"code":"4000247","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":506,"gross_charge":533,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Malignant Lesion 1-2cm","code_information":[{"code":"8011602","type":"CDM"},{"code":"521","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366,"maximum":506,"gross_charge":533,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":506},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":366},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Patient office consultation, 60 min","code_information":[{"code":"8099244","type":"CDM"},{"code":"521","type":"RC"},{"code":"99244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":440,"maximum":505,"gross_charge":532,"discounted_cash":479,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":440}]}]},{"description":"Paring Or Cutting Of Corn Or Callus","code_information":[{"code":"1090054","type":"CDM"},{"code":"450","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":504,"gross_charge":531,"discounted_cash":478,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":439}]}]},{"description":"Mal Lesion Face .6-1cm","code_information":[{"code":"8011641","type":"CDM"},{"code":"521","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":504,"gross_charge":531,"discounted_cash":478,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":350},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":439}]}]},{"description":"Cl-gardasil (Human Papillomavirus Quad)","code_information":[{"code":"3000086","type":"CDM"},{"code":"250","type":"RC"},{"code":"64121","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":438,"maximum":504,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":438}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cl-gardasil","code_information":[{"code":"3000087","type":"CDM"},{"code":"250","type":"RC"},{"code":"64121","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":438,"maximum":504,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":438}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xr Scoliosis Survey 2 Or 3 Views","code_information":[{"code":"5010086","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":504,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":438}]}]},{"description":"Tc99m Tetrofosmin","code_information":[{"code":"5081020","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":504,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":438}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Replace G Tube","code_information":[{"code":"240064","type":"CDM"},{"code":"761","type":"RC"},{"code":"43762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":502,"gross_charge":528,"discounted_cash":475,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"Replace Gtube","code_information":[{"code":"1090041","type":"CDM"},{"code":"450","type":"RC"},{"code":"43762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":502,"gross_charge":528,"discounted_cash":475,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"7599205","type":"CDM"},{"code":"940","type":"RC"},{"code":"99205","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":435,"maximum":500,"gross_charge":526,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":435}]}]},{"description":"Fracture Clavical-clsd","code_information":[{"code":"8023500","type":"CDM"},{"code":"521","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":493,"gross_charge":511,"discounted_cash":460,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":493},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Respite Care Level 1","code_information":[{"code":"100001","type":"CDM"},{"code":"120","type":"RC"},{"code":"CP100001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":413,"maximum":475,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":413}]}]},{"description":"Xr Dxa Bone Density","code_information":[{"code":"5010011","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":474,"gross_charge":499,"discounted_cash":449,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":412}]}]},{"description":"Removal Foreign Body Skin Simple","code_information":[{"code":"1090038","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":471,"gross_charge":496,"discounted_cash":446,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":410}]}]},{"description":"Crcam Monitor > 48hr-7day","code_information":[{"code":"5500001","type":"CDM"},{"code":"731","type":"RC"},{"code":"93242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":466,"gross_charge":491,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Zio Over 48 Hr To 7 Day Monitor","code_information":[{"code":"5500002","type":"CDM"},{"code":"731","type":"RC"},{"code":"93242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":466,"gross_charge":491,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Xr Pelvis Minimum 3 Views","code_information":[{"code":"5010074","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":464,"gross_charge":488,"discounted_cash":439,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":403}]}]},{"description":"Cmplx Repr Face 1.1-2.5cm","code_information":[{"code":"1090071","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":558,"gross_charge":486,"discounted_cash":437,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":423},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":558},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"Xr Hip Bilateral 2 Views","code_information":[{"code":"5010051","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":459,"gross_charge":483,"discounted_cash":435,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Human Papil Vac 3 Dose","code_information":[{"code":"8090649","type":"CDM"},{"code":"250","type":"RC"},{"code":"90651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397,"maximum":456,"gross_charge":480,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Gardasil 9","code_information":[{"code":"8090651","type":"CDM"},{"code":"250","type":"RC"},{"code":"90651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397,"maximum":456,"gross_charge":480,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Xr Ribs Bilateral 3 Views","code_information":[{"code":"5010075","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":454,"gross_charge":478,"discounted_cash":430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":395}]}]},{"description":"Xr Orbits Minimum 4 Views","code_information":[{"code":"5010070","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":451,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":393}]}]},{"description":"Mammography of both breasts","code_information":[{"code":"5477066","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":377,"maximum":450,"gross_charge":474,"discounted_cash":427,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":377},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":392}]}]},{"description":"Us Pelvis Limited","code_information":[{"code":"5130010","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":446,"gross_charge":469,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":388},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":269}]}]},{"description":"Fracture Distal Finger","code_information":[{"code":"8026750","type":"CDM"},{"code":"521","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":387,"maximum":445,"gross_charge":468,"discounted_cash":421,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":411},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":387}]}]},{"description":"Calprotectin Stool","code_information":[{"code":"4000061","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":443,"gross_charge":466,"discounted_cash":419,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":385}]}]},{"description":"Xr Skull Minimum 4 Views","code_information":[{"code":"5010001","type":"CDM"},{"code":"420","type":"RC"},{"code":"70260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":443,"gross_charge":466,"discounted_cash":419,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":385}]}]},{"description":"Xr Mandible Minimum 4 Views","code_information":[{"code":"5010067","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":441,"gross_charge":464,"discounted_cash":418,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":383}]}]},{"description":"Cl-prevnar 13 (Pneumococ 13-valent Conj)","code_information":[{"code":"3000103","type":"CDM"},{"code":"636","type":"RC"},{"code":"51971","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":382,"maximum":439,"gross_charge":462,"discounted_cash":416,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Thyroid Stimulating Immunoglobulins-seru","code_information":[{"code":"4000433","type":"CDM"},{"code":"300","type":"RC"},{"code":"84445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":439,"gross_charge":462,"discounted_cash":416,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}]},{"description":"Xr Facial Bones Minimum 3 Views","code_information":[{"code":"5010030","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":439,"gross_charge":462,"discounted_cash":416,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":382}]}]},{"description":"Prevnar 13","code_information":[{"code":"8090670","type":"CDM"},{"code":"636","type":"RC"},{"code":"90670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":439,"gross_charge":462,"discounted_cash":416,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":382},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":402},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":402}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ql Hiv 1 Rna, Ql Rt Pcr","code_information":[{"code":"4000257","type":"CDM"},{"code":"300","type":"RC"},{"code":"87535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":436,"gross_charge":459,"discounted_cash":413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":379}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"8099205","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":435,"gross_charge":458,"discounted_cash":412,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":210},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":379}]}]},{"description":"Fracture Care Finger/thum","code_information":[{"code":"8026720","type":"CDM"},{"code":"521","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":376,"maximum":432,"gross_charge":455,"discounted_cash":410,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":376}]}]},{"description":"Xr Knee Minimum 4 Views (Lt)","code_information":[{"code":"5010058","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":375,"maximum":431,"gross_charge":454,"discounted_cash":409,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375}]}]},{"description":"Xr Knee Minimum 4 Views (Rt)","code_information":[{"code":"5010060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":375,"maximum":431,"gross_charge":454,"discounted_cash":409,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":375}]}]},{"description":"Cl-proquad 0.5ml","code_information":[{"code":"3000104","type":"CDM"},{"code":"636","type":"RC"},{"code":"64984","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":372,"maximum":428,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Proquad","code_information":[{"code":"8090710","type":"CDM"},{"code":"636","type":"RC"},{"code":"90710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":428,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":372}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Acetylcholine Receptor Antibodies-serum","code_information":[{"code":"4000007","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":425,"gross_charge":447,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"Alpha Subunit","code_information":[{"code":"4000020","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":425,"gross_charge":447,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"Myasthenia Gravis Panel 2","code_information":[{"code":"4000315","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":425,"gross_charge":447,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"Xr L-spine 2 Or 3 Views","code_information":[{"code":"5010064","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":425,"gross_charge":447,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"Xr Scoliosis Survey 1 View","code_information":[{"code":"5010085","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":420,"gross_charge":442,"discounted_cash":398,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365}]}]},{"description":"Excision Malignant Trunk .6 To 1 Cm","code_information":[{"code":"8011601","type":"CDM"},{"code":"521","type":"RC"},{"code":"11601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":334,"maximum":420,"gross_charge":442,"discounted_cash":398,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":334},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":365}]}]},{"description":"Treat Hip Dislocation","code_information":[{"code":"1090045","type":"CDM"},{"code":"450","type":"RC"},{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":419,"gross_charge":441,"discounted_cash":397,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":402},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364}]}]},{"description":"Tap 2.0 Stand Reposition Turn Sheet","code_information":[{"code":"2589962","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589962","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":418,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364}]}]},{"description":"I&d Cyst Multiple","code_information":[{"code":"8010061","type":"CDM"},{"code":"521","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":364,"maximum":418,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":405},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":364}]}]},{"description":"Us Breast Limited (Lt)","code_information":[{"code":"5130004","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":417,"gross_charge":439,"discounted_cash":395,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":252}]}]},{"description":"Us Breast Limited (Rt)","code_information":[{"code":"5130018","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":417,"gross_charge":439,"discounted_cash":395,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":252}]}]},{"description":"Laceration 2.6-7.5cm","code_information":[{"code":"1090034","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":416,"gross_charge":438,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362}]}]},{"description":"Xr Chest 3 Views","code_information":[{"code":"5010020","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":414,"gross_charge":436,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"Xr Chest W/oblique Projections Min 3v","code_information":[{"code":"5010023","type":"CDM"},{"code":"320","type":"RC"},{"code":"71047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":414,"gross_charge":436,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"Excision 2.1 To 3.0 Cm Benign Lesion","code_information":[{"code":"8011423","type":"CDM"},{"code":"521","type":"RC"},{"code":"11423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348,"maximum":413,"gross_charge":435,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":348},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360}]}]},{"description":"Chiropractic, Pt Office Visit 40 Min","code_information":[{"code":"7599215","type":"CDM"},{"code":"940","type":"RC"},{"code":"99215","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":358,"maximum":411,"gross_charge":433,"discounted_cash":390,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":358}]}]},{"description":"Xr Ribs W/chest Minimum 3 Views (Lt)","code_information":[{"code":"5010078","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":356,"maximum":409,"gross_charge":431,"discounted_cash":388,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356}]}]},{"description":"Xr Ribs W/chest Minimum 3 Views (Rt)","code_information":[{"code":"5010080","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":356,"maximum":409,"gross_charge":431,"discounted_cash":388,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":356}]}]},{"description":"Benign Lesion Face 1-2cm","code_information":[{"code":"8011442","type":"CDM"},{"code":"521","type":"RC"},{"code":"11442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":323,"maximum":408,"gross_charge":429,"discounted_cash":386,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":355}]}]},{"description":"Change Of Cystostomy Tube Simple","code_information":[{"code":"7920009","type":"CDM"},{"code":"761","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":406,"gross_charge":427,"discounted_cash":384,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":353}]}]},{"description":"Infectious Agent Detection By Nucleic Ac","code_information":[{"code":"4000353","type":"CDM"},{"code":"300","type":"RC"},{"code":"87632","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":351,"maximum":404,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351}]}]},{"description":"Xr Sinuses Minimum 3 Views","code_information":[{"code":"5010092","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":403,"gross_charge":424,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Cr 6 Min Walk Test Pulmonary Stress Test","code_information":[{"code":"6600043","type":"CDM"},{"code":"480","type":"RC"},{"code":"94618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":402,"gross_charge":423,"discounted_cash":381,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"System Chest Drain Adult/ped","code_information":[{"code":"2589726","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589726","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":401,"gross_charge":422,"discounted_cash":380,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349}]}]},{"description":"Us Retroperitoneal (Aorta) Limited","code_information":[{"code":"5130016","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":399,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":241}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"5477067","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":399,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":303},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":365},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":365}]}]},{"description":"Benign Lesion 2.1-3cm","code_information":[{"code":"8011403","type":"CDM"},{"code":"521","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":328,"maximum":399,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":328},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":347}]}]},{"description":"Diazepam Injection Solution 5mg/1ml","code_information":[{"code":"69339136","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339013603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":347,"maximum":399,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":347}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Laceration 7.6-12.5cm","code_information":[{"code":"8012004","type":"CDM"},{"code":"521","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":397,"gross_charge":418,"discounted_cash":376,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"Obs Iv Therapy Initial","code_information":[{"code":"240069","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":395,"gross_charge":416,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Tr Iv Therapy Initial","code_information":[{"code":"246408","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":395,"gross_charge":416,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Er Iv Therapy Initial","code_information":[{"code":"1090030","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":395,"gross_charge":416,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Removal Nail Permanentingrown / Defor","code_information":[{"code":"8011750","type":"CDM"},{"code":"521","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":395,"gross_charge":416,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Amino Acid Analysis","code_information":[{"code":"4000022","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":392,"gross_charge":413,"discounted_cash":372,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":341}]}]},{"description":"Cl-bexsero 0.5ml","code_information":[{"code":"3000075","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":339,"maximum":390,"gross_charge":410,"discounted_cash":369,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":339}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Bexserogroup B 2 Dose","code_information":[{"code":"8090620","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":339,"maximum":390,"gross_charge":410,"discounted_cash":369,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":339}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Evacuation Of Subungual (Nail) Hematoma","code_information":[{"code":"10940049","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":383,"gross_charge":403,"discounted_cash":363,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":333}]}]},{"description":"Obs Hydration Iv Initial","code_information":[{"code":"240071","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":399,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Tr Hydration Iv Initial","code_information":[{"code":"246405","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":399,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Er Hydration Iv Initial","code_information":[{"code":"1090024","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":399,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"I&d Hematoma","code_information":[{"code":"8010140","type":"CDM"},{"code":"521","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":380,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Xr Knee 3 Views (Rt)","code_information":[{"code":"5010054","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":330,"maximum":379,"gross_charge":399,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":330}]}]},{"description":"Xr Knee 3 Views (Lt)","code_information":[{"code":"5010055","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":330,"maximum":379,"gross_charge":399,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":330}]}]},{"description":"Oxygen","code_information":[{"code":"6700028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":329,"maximum":378,"gross_charge":398,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":329}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"7599204","type":"CDM"},{"code":"940","type":"RC"},{"code":"99204","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":329,"maximum":378,"gross_charge":398,"discounted_cash":358,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":329}]}]},{"description":"Xr Abdomen Minimum 2 Views","code_information":[{"code":"5010003","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":375,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Xr Sacroiliac Joints Minimum 3 Views","code_information":[{"code":"5010082","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":375,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"New Pt Nursing Home 45 Min","code_information":[{"code":"8099306","type":"CDM"},{"code":"525","type":"RC"},{"code":"99306","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":326,"maximum":375,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Laceration Face 2.6-5cm","code_information":[{"code":"8012013","type":"CDM"},{"code":"521","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":374,"gross_charge":394,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"CP17730782582537084","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":372,"gross_charge":392,"discounted_cash":353,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"Electrocardiogram, routine, with interpretation and report","code_information":[{"code":"5500008","type":"CDM"},{"code":"730","type":"RC"},{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":372,"gross_charge":392,"discounted_cash":353,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"Mammography of one breast","code_information":[{"code":"5417065","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":323,"maximum":371,"gross_charge":391,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Mammography of one breast","code_information":[{"code":"5477065","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":323,"maximum":371,"gross_charge":391,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":323}]}]},{"description":"Xr Sacroiliac Joints Less Than 3 Views","code_information":[{"code":"5010081","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":371,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Ez-io 25mm Needle 5/bx","code_information":[{"code":"2589851","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589851","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":370,"gross_charge":389,"discounted_cash":350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Ez-io 45mm Needle 5/bx","code_information":[{"code":"2589852","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589852","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":370,"gross_charge":389,"discounted_cash":350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Respiratory Probe","code_information":[{"code":"4000377","type":"CDM"},{"code":"300","type":"RC"},{"code":"87633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":319,"maximum":849,"gross_charge":386,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":849},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":319}]}]},{"description":"Compatibility Testing Ahg","code_information":[{"code":"4000478","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":366,"gross_charge":385,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":318}]}]},{"description":"Delivery Of Placenta (Separate Procedure","code_information":[{"code":"8309414","type":"CDM"},{"code":"521","type":"RC"},{"code":"59414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":366,"gross_charge":385,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":318}]}]},{"description":"Malgnt Lesion Face <.5cm","code_information":[{"code":"8011640","type":"CDM"},{"code":"521","type":"RC"},{"code":"11640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":365,"gross_charge":384,"discounted_cash":346,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":317}]}]},{"description":"O2 @  10l/min Simple Mask","code_information":[{"code":"6700022","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  2l/min Nc","code_information":[{"code":"6700023","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  5l/min Nc","code_information":[{"code":"6700024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  8l/min Simple Mask","code_information":[{"code":"6700025","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 12l/min Non Rebreather","code_information":[{"code":"6700026","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 14l/min Non Rebreather","code_information":[{"code":"6700027","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  7l/min Simple Mask","code_information":[{"code":"6700029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 13l/min Non Rebreather","code_information":[{"code":"6700030","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 15l/min Non Rebreather","code_information":[{"code":"6700031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  4l/min Nc","code_information":[{"code":"6700032","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  9l/min Simple Mask","code_information":[{"code":"6700033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 6l/min Simple Mask","code_information":[{"code":"6700034","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @  3l/min Nc","code_information":[{"code":"6700035","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"O2 @ 11l/min Non Rebreather","code_information":[{"code":"6700036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":363,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Closed Treat Toe Dislocation Wo Anes","code_information":[{"code":"1090009","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":362,"gross_charge":381,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":248},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Xr Elbow 2 Views (Lt)","code_information":[{"code":"5010026","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":314,"maximum":361,"gross_charge":380,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":314}]}]},{"description":"Laceration <2.5cm","code_information":[{"code":"1090033","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":359,"gross_charge":378,"discounted_cash":340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":312}]}]},{"description":"Gastrostomy Feeding Tube Low Profile Mic","code_information":[{"code":"2589926","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589926","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":356,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310}]}]},{"description":"Xr T-spine 2 Views","code_information":[{"code":"5010098","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":355,"gross_charge":374,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":309}]}]},{"description":"Acetaminophen","code_information":[{"code":"4000006","type":"CDM"},{"code":"300","type":"RC"},{"code":"80143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":354,"gross_charge":373,"discounted_cash":336,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":308}]}]},{"description":"Xr C-spine 2 Or 3 Views","code_information":[{"code":"5010015","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":352,"gross_charge":371,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Xr Scapula Complete (Rt)","code_information":[{"code":"5010084","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":307,"maximum":352,"gross_charge":371,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Xr Scapula Complete (Lt)","code_information":[{"code":"5010110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":307,"maximum":352,"gross_charge":371,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Closed Tx Fracture Toe(s) W/ Manip","code_information":[{"code":"8028515","type":"CDM"},{"code":"521","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":352,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306}]}]},{"description":"Disability Evaluation","code_information":[{"code":"8099455","type":"CDM"},{"code":"521","type":"RC"},{"code":"99455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":351,"gross_charge":369,"discounted_cash":332,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":305}]}]},{"description":"Fx Care Fingers With Manipulation","code_information":[{"code":"1090051","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":648,"gross_charge":366,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":648},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Xr Chest Special View(lateral Decubitus)","code_information":[{"code":"5010022","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":348,"gross_charge":366,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Welcome To Mc Px","code_information":[{"code":"8070402","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0402","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":301,"maximum":346,"gross_charge":364,"discounted_cash":328,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Xr Shoulder Minimum 2 Views (Rt)","code_information":[{"code":"5010088","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":300,"maximum":345,"gross_charge":363,"discounted_cash":327,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Xr Shoulder Minimum 2 Views (Lt)","code_information":[{"code":"5010090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":300,"maximum":345,"gross_charge":363,"discounted_cash":327,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Stabilizer Pelvic T-pod Orange","code_information":[{"code":"2589948","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589948","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":344,"gross_charge":362,"discounted_cash":326,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Sp Spirometry Forced Vital Cap Wo Bronco","code_information":[{"code":"5090100","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":344,"gross_charge":362,"discounted_cash":326,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Benign Lesion 1-2cm","code_information":[{"code":"8011402","type":"CDM"},{"code":"521","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":343,"gross_charge":361,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Methylmalonic Acid Gc/ms/ms","code_information":[{"code":"4000306","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":342,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Xr Chest Minimum 4 Views","code_information":[{"code":"5010021","type":"CDM"},{"code":"320","type":"RC"},{"code":"71048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":342,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Incision Of Ext Hemorroid","code_information":[{"code":"8046083","type":"CDM"},{"code":"521","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":342,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Xr Thoracolumbar Spine Minimum 2 Views","code_information":[{"code":"5010099","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":341,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":297}]}]},{"description":"St Speech Evaluation & Treatment","code_information":[{"code":"6300004","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":297,"maximum":341,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":297}]}]},{"description":"St Eval Of Speech And Sound Production","code_information":[{"code":"6300006","type":"CDM"},{"code":"440","type":"RC"},{"code":"92522","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":297,"maximum":341,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":297}]}]},{"description":"Xr Femur 2 Views (Lt)","code_information":[{"code":"5010032","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":294,"maximum":338,"gross_charge":356,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":294}]}]},{"description":"Xr Femur 2 Views (Rt)","code_information":[{"code":"5010034","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":294,"maximum":338,"gross_charge":356,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":294}]}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"5010019","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":336,"gross_charge":354,"discounted_cash":319,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":293}]}]},{"description":"Incisional Biopsy Single","code_information":[{"code":"8011106","type":"CDM"},{"code":"521","type":"RC"},{"code":"11106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":336,"gross_charge":354,"discounted_cash":319,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":293}]}]},{"description":"Xr Elbow Minimum 3 Views (Lt)","code_information":[{"code":"5010027","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":292,"maximum":335,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Xr Elbow Minimum 3 Views (Rt)","code_information":[{"code":"5020027","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":292,"maximum":335,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"St Dysphagia Evaluation","code_information":[{"code":"6300001","type":"CDM"},{"code":"444","type":"RC"},{"code":"92610","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":292,"maximum":335,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Malgnt Lesion Other<.5cm","code_information":[{"code":"8011620","type":"CDM"},{"code":"521","type":"RC"},{"code":"11620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":271,"maximum":335,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Factor V Leiden Mutation Analysis-blood","code_information":[{"code":"4000194","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":334,"gross_charge":352,"discounted_cash":317,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"8099204","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":334,"gross_charge":352,"discounted_cash":317,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291}]}]},{"description":"Er- Level 2minor Er Visit","code_information":[{"code":"1090015","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":333,"gross_charge":351,"discounted_cash":316,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290}]}]},{"description":"125-dihydroxy-vitamin D-serum","code_information":[{"code":"4000465","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":333,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":289}]}]},{"description":"Physical 65 And Over","code_information":[{"code":"8099387","type":"CDM"},{"code":"521","type":"RC"},{"code":"99387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":333,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":289}]}]},{"description":"Xr Nasal Bones Minimum 3 Views","code_information":[{"code":"5010068","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":332,"gross_charge":349,"discounted_cash":314,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Observ Direct Admit By Physician","code_information":[{"code":"240061","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":285,"maximum":328,"gross_charge":345,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":285}]}]},{"description":"Application Long Leg Splint","code_information":[{"code":"1090003","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":327,"gross_charge":344,"discounted_cash":310,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":284}]}]},{"description":"Xr Hip 2 Or 3 Views W/pelvis (Lt)","code_information":[{"code":"5010047","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":283,"maximum":326,"gross_charge":343,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Xr Hip 2 Or 3 Views W/pelvis (Rt)","code_information":[{"code":"5010048","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":283,"maximum":326,"gross_charge":343,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Streptococcus Dysgalactiae","code_information":[{"code":"4000282","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":283,"maximum":325,"gross_charge":342,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Bordetella Parapertussis","code_information":[{"code":"4000392","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":283,"maximum":325,"gross_charge":342,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Bordetella Pertussis","code_information":[{"code":"4000394","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":283,"maximum":325,"gross_charge":342,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283}]}]},{"description":"Xr Ankle Minimum 3 Views (Lt)","code_information":[{"code":"5010007","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":281,"maximum":323,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"Xr Ankle Minimum 3 Views (Rt)","code_information":[{"code":"5010009","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":281,"maximum":323,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"Acute Hepatitis Panel","code_information":[{"code":"4000011","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":322,"gross_charge":339,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Laceration 2.6-7.5cm","code_information":[{"code":"8012002","type":"CDM"},{"code":"521","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":322,"gross_charge":339,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Foot Minimum 3 Views (Lt)","code_information":[{"code":"5010037","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":279,"maximum":321,"gross_charge":338,"discounted_cash":304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Xr Foot Minimum 3 Views (Rt)","code_information":[{"code":"5010039","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":279,"maximum":321,"gross_charge":338,"discounted_cash":304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Xr Sternum Minimum 2 Views","code_information":[{"code":"5010097","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":320,"gross_charge":337,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Treatment Room 2","code_information":[{"code":"7920002","type":"CDM"},{"code":"761","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":320,"gross_charge":337,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Lifevac Choking Rescue Device","code_information":[{"code":"2589968","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589968","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":319,"gross_charge":336,"discounted_cash":302,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Control Nasal Hemorrhage Simple","code_information":[{"code":"1090010","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":317,"gross_charge":334,"discounted_cash":301,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Malignant Lesion .5","code_information":[{"code":"8011600","type":"CDM"},{"code":"521","type":"RC"},{"code":"11600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":317,"gross_charge":334,"discounted_cash":301,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Xr Ribs 2 Views (Lt)","code_information":[{"code":"5010077","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":275,"maximum":316,"gross_charge":333,"discounted_cash":300,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Xr Ribs 2 Views (Rt)","code_information":[{"code":"5010079","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":275,"maximum":316,"gross_charge":333,"discounted_cash":300,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Ip/obs Ekg After Hours","code_information":[{"code":"100050","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Obs Hydration Iv Add'l Hrs","code_information":[{"code":"240074","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Tr Hydration Iv Add'l Hrs","code_information":[{"code":"246406","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Er Hydration Iv Add'l Hrs","code_information":[{"code":"1090023","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Er Ekg After Hours","code_information":[{"code":"1090050","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Xr Sacrum And Coccyx Minimum 2 Views","code_information":[{"code":"5010083","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Ekg Inpatient/observation","code_information":[{"code":"5500003","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Er Ekg","code_information":[{"code":"5500004","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Ekg Electrocardiogram Radiology","code_information":[{"code":"5500005","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Er Ekg 12 Lead Chest Pain/rhythm Abn","code_information":[{"code":"5500006","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Preliminary Ekg Stress (Sit/stand)","code_information":[{"code":"6693005","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Benign Lesion Face .5-1cm","code_information":[{"code":"8011441","type":"CDM"},{"code":"521","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":315,"gross_charge":332,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Xr Pelvis 1 Or 2 Views","code_information":[{"code":"5010073","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":314,"gross_charge":331,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Xr Soft Tissue Neck","code_information":[{"code":"5010095","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":314,"gross_charge":331,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274}]}]},{"description":"Xr Hand Minimum 3 Views (Lt)","code_information":[{"code":"5010043","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":273,"maximum":314,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Xr Hand Minimum 3 Views (Rt)","code_information":[{"code":"5010045","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":273,"maximum":314,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Xr Humerus Minimum 2 Views (Rt)","code_information":[{"code":"5010052","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":273,"maximum":314,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Xr Humerus Minimum 2 Views (Lt)","code_information":[{"code":"5010108","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":273,"maximum":314,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Puncture Aspiration","code_information":[{"code":"8010160","type":"CDM"},{"code":"521","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":314,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":273}]}]},{"description":"Xr Knee 1 Or 2 Views (Lt)","code_information":[{"code":"5010057","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":271,"maximum":312,"gross_charge":328,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"Xr Knee 1 Or 2 Views (Rt)","code_information":[{"code":"5010059","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":271,"maximum":312,"gross_charge":328,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":271}]}]},{"description":"Removal Fbskinsimple","code_information":[{"code":"8010120","type":"CDM"},{"code":"521","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":311,"gross_charge":327,"discounted_cash":294,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Laceration Face <2.5cm","code_information":[{"code":"1090035","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":310,"gross_charge":326,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"Cardiac Monitoring Continuous Telemetry","code_information":[{"code":"410010","type":"CDM"},{"code":"732","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":308,"gross_charge":324,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":268}]}]},{"description":"Initial new patient preventative medicine evaluation (40-64 years)","code_information":[{"code":"8099386","type":"CDM"},{"code":"521","type":"RC"},{"code":"99386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":308,"gross_charge":324,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":268}]}]},{"description":"Removal Nail Plate","code_information":[{"code":"1090039","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":307,"gross_charge":323,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Xr Wrist Minimum 3 Views (Lt)","code_information":[{"code":"5010105","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":267,"maximum":307,"gross_charge":323,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Xr Wrist Minimum 3 Views (Rt)","code_information":[{"code":"5010107","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":267,"maximum":307,"gross_charge":323,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Kinevac","code_information":[{"code":"5081037","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":307,"gross_charge":323,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Outpt Visit Compreh","code_information":[{"code":"8099215","type":"CDM"},{"code":"521","type":"RC"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":307,"gross_charge":323,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":199},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"Histoplasma Antigen-urine","code_information":[{"code":"4000254","type":"CDM"},{"code":"300","type":"RC"},{"code":"87385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":306,"gross_charge":322,"discounted_cash":290,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266}]}]},{"description":"Benign Lesion Other .6-1c","code_information":[{"code":"8011421","type":"CDM"},{"code":"521","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":306,"gross_charge":322,"discounted_cash":290,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266}]}]},{"description":"Xr Lower Extremity Infant Min 2 Vie (Rt)","code_information":[{"code":"5010061","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":265,"maximum":305,"gross_charge":321,"discounted_cash":289,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Xr Lower Extremity Infant Min 2 Vie (Lt)","code_information":[{"code":"5010111","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":265,"maximum":305,"gross_charge":321,"discounted_cash":289,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Laceration Face <2.5cm","code_information":[{"code":"8012011","type":"CDM"},{"code":"521","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":305,"gross_charge":321,"discounted_cash":289,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Acth Plasma","code_information":[{"code":"4000009","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":302,"gross_charge":318,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Anca Screen With Reflex To Titer","code_information":[{"code":"4000028","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":302,"gross_charge":318,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Xr Lower Leg 2 Views (Lt)","code_information":[{"code":"5010062","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":263,"maximum":302,"gross_charge":318,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Xr Lower Leg 2 Views (Rt)","code_information":[{"code":"5010063","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":263,"maximum":302,"gross_charge":318,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Wedge Excision Of Nailingrown Toenail","code_information":[{"code":"8011765","type":"CDM"},{"code":"521","type":"RC"},{"code":"11765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":300,"gross_charge":316,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Comp Repair Each Addl 5cm Or Less","code_information":[{"code":"1090065","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":299,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Cl-pneumococcal 20","code_information":[{"code":"3000448","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":260,"maximum":299,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Pancreatic Elastase-i","code_information":[{"code":"4000064","type":"CDM"},{"code":"300","type":"RC"},{"code":"82653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":299,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Xr Abdomen 1 View","code_information":[{"code":"5010002","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":299,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Cl-prevnar 20","code_information":[{"code":"8090677","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":260,"maximum":299,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Nsrg Home Visit Subsequen","code_information":[{"code":"8099310","type":"CDM"},{"code":"525","type":"RC"},{"code":"99310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":251,"maximum":298,"gross_charge":314,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":251},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"St Speech/language Treatment","code_information":[{"code":"6300005","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":258,"maximum":296,"gross_charge":312,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Mc Annual Pxinitial","code_information":[{"code":"8070438","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0438","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":258,"maximum":296,"gross_charge":312,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Benign Lesion .6-1.0 Cm","code_information":[{"code":"8011401","type":"CDM"},{"code":"521","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":295,"gross_charge":311,"discounted_cash":280,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":257}]}]},{"description":"Cl-zostavax (Zoster Vaccine Live)","code_information":[{"code":"3000116","type":"CDM"},{"code":"250","type":"RC"},{"code":"64963","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":256,"maximum":295,"gross_charge":310,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zostivaxshingles Vaccine","code_information":[{"code":"8090736","type":"CDM"},{"code":"250","type":"RC"},{"code":"90736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":295,"gross_charge":310,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":256}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cr Dual Icd Evaluation","code_information":[{"code":"6693283","type":"CDM"},{"code":"480","type":"RC"},{"code":"93283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":294,"gross_charge":309,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Peds Cricothyrotomy Kit 5cc","code_information":[{"code":"2589963","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589963","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":293,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Xr Hip 1 View W/pelvis (Lt)","code_information":[{"code":"5010049","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":255,"maximum":293,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Xr Hip 1 View W/pelvis (Rt)","code_information":[{"code":"5010050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":255,"maximum":293,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Chiropractic, Pt Office Visit 25 Min","code_information":[{"code":"7599214","type":"CDM"},{"code":"940","type":"RC"},{"code":"99214","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":255,"maximum":293,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Obs Iv Therapy Additional Hours","code_information":[{"code":"240072","type":"CDM"},{"code":"761","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":292,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Tr Iv Therapy Additional Hours","code_information":[{"code":"246407","type":"CDM"},{"code":"761","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":292,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Er Iv Therapy Additional Hours","code_information":[{"code":"1090029","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":292,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Omnipaque 300 100ml","code_information":[{"code":"2589985","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":292,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Shave Biopsy Neck 0.5cm Or Less","code_information":[{"code":"8011305","type":"CDM"},{"code":"521","type":"RC"},{"code":"11305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":292,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254}]}]},{"description":"Long Arm Cast","code_information":[{"code":"8029065","type":"CDM"},{"code":"521","type":"RC"},{"code":"29065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":291,"gross_charge":306,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":253}]}]},{"description":"Xr Facial Bones Less Than 3 Views","code_information":[{"code":"5010029","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":290,"gross_charge":305,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"Xr Mandible Less Than 4 Views","code_information":[{"code":"5010066","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":290,"gross_charge":305,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"Delivery Of Placenta (Separate Procedure","code_information":[{"code":"1090012","type":"CDM"},{"code":"450","type":"RC"},{"code":"59414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":288,"gross_charge":303,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Acromioclavicular Joints Bilateral","code_information":[{"code":"5010005","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":288,"gross_charge":303,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Skull Less Than 4 Views","code_information":[{"code":"5010093","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":288,"gross_charge":303,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Clavicle Complete (Rt)","code_information":[{"code":"5010025","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":250,"maximum":287,"gross_charge":302,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Femur 1 View (Lt)","code_information":[{"code":"5010031","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":250,"maximum":287,"gross_charge":302,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Femur 1 View (Rt)","code_information":[{"code":"5010033","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":250,"maximum":287,"gross_charge":302,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Xr Clavicle Complete (Lt)","code_information":[{"code":"5010112","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":250,"maximum":287,"gross_charge":302,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250}]}]},{"description":"Obs Aerosol Inhalation Treatment","code_information":[{"code":"240065","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":286,"gross_charge":301,"discounted_cash":271,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Tr Aerosol Inhalation Treatment","code_information":[{"code":"240066","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":286,"gross_charge":301,"discounted_cash":271,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Aerosol Inhalation Treatment","code_information":[{"code":"1090002","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":286,"gross_charge":301,"discounted_cash":271,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Diastat Acudial Gel 10mg","code_information":[{"code":"3000139","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":248,"maximum":285,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Compatibility Test-immediate Spin Phase1","code_information":[{"code":"4000090","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Compatibility Test-immediate Spin Phase2","code_information":[{"code":"4000094","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Compatibility Test-immediate Spin Phase3","code_information":[{"code":"4000095","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Compatibility Test-immediate Spin Phase4","code_information":[{"code":"4000096","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Dexamethasone-serum","code_information":[{"code":"4000173","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Rsv","code_information":[{"code":"4000387","type":"CDM"},{"code":"300","type":"RC"},{"code":"86756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Pro-bnp","code_information":[{"code":"4000482","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":282,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Xr Sinuses Less Than 3 Views","code_information":[{"code":"5010091","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":281,"gross_charge":296,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"Simple, Drainage External Ear, Abscess","code_information":[{"code":"8069000","type":"CDM"},{"code":"521","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":244,"maximum":280,"gross_charge":295,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244}]}]},{"description":"Cl-menactra 0.5ml","code_information":[{"code":"3000096","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281059010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":243,"maximum":279,"gross_charge":294,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cl-menveo (Meningococcal)0.5ml","code_information":[{"code":"3000097","type":"CDM"},{"code":"250","type":"RC"},{"code":"46028020801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":243,"maximum":279,"gross_charge":294,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Menactra .5 Ml","code_information":[{"code":"8090734","type":"CDM"},{"code":"250","type":"RC"},{"code":"90734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":279,"gross_charge":294,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Respiratory Virus Infectious Agent Detec","code_information":[{"code":"4000358","type":"CDM"},{"code":"300","type":"RC"},{"code":"87631","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":241,"maximum":277,"gross_charge":292,"discounted_cash":263,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Parathyroid Hormone Intact (Pth)-serum","code_information":[{"code":"4000338","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":276,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"St Dysphagia Treatment","code_information":[{"code":"6300002","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":241,"maximum":276,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"St Evaluation Of Speech Fluency","code_information":[{"code":"6300003","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":241,"maximum":276,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Immunofixation Serum","code_information":[{"code":"4000278","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":276,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Xr Chest 1 View","code_information":[{"code":"5010018","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":276,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Arterial Blood Gas Panel","code_information":[{"code":"4000003","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Arterial Blood Gas","code_information":[{"code":"4000041","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Immunofixation Urine","code_information":[{"code":"4000279","type":"CDM"},{"code":"300","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Venous Blood-blood Gas","code_information":[{"code":"4000460","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Cr Phase Ii Monitored-mc","code_information":[{"code":"6693797","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Crphase Ii Monitored","code_information":[{"code":"6693798","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Kx Cr Phase Ii Monitored","code_information":[{"code":"6693799","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT","modifier":"KX"}],"standard_charges":[{"setting":"outpatient","modifier_code":["KX"],"minimum":239,"maximum":275,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Hsv Type I And Type Ii","code_information":[{"code":"4000269","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":274,"gross_charge":288,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Punch Biopsy","code_information":[{"code":"8011104","type":"CDM"},{"code":"521","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":274,"gross_charge":288,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Laceration <2.5 Cm","code_information":[{"code":"8012001","type":"CDM"},{"code":"521","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":274,"gross_charge":288,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Destruction, Malignant Lesion .5cm Or Le","code_information":[{"code":"8017270","type":"CDM"},{"code":"521","type":"RC"},{"code":"17270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":273,"gross_charge":287,"discounted_cash":258,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":237}]}]},{"description":"Patient office consultation, 40 min","code_information":[{"code":"8099243","type":"CDM"},{"code":"521","type":"RC"},{"code":"99243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":237,"maximum":273,"gross_charge":287,"discounted_cash":258,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":237}]}]},{"description":"Anesthesia Equipment & Supply","code_information":[{"code":"2820011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2820011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":236,"maximum":272,"gross_charge":286,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Benign Lesion Face <.5cm","code_information":[{"code":"8011440","type":"CDM"},{"code":"521","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":272,"gross_charge":286,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Application Gauntlet Cast","code_information":[{"code":"8029085","type":"CDM"},{"code":"521","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":272,"gross_charge":286,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Short Arm Splint Application","code_information":[{"code":"1090042","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":271,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Xr Forearm 2 Views (Lt)","code_information":[{"code":"5010040","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":236,"maximum":271,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Xr Forearm 2 Views (Rt)","code_information":[{"code":"5010041","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":236,"maximum":271,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Nephelometry","code_information":[{"code":"4000472","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":270,"gross_charge":284,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Pt Eval High Complexity","code_information":[{"code":"6197163","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":235,"maximum":270,"gross_charge":284,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Prevalon Mat Only System 10 10/cs","code_information":[{"code":"2589833","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":268,"gross_charge":282,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"Culture Blood","code_information":[{"code":"4000150","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":266,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Xr Spine Cerv/thor Spot Level 1 View","code_information":[{"code":"5010096","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":266,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Xr Elbow 2 Views (Rt)","code_information":[{"code":"5020026","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":231,"maximum":266,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Hiv Antibody Hiv 1 Western Blot","code_information":[{"code":"4000261","type":"CDM"},{"code":"300","type":"RC"},{"code":"86689","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":265,"gross_charge":279,"discounted_cash":251,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Initial new patient preventative medicine evaluation (18-39 years)","code_information":[{"code":"8099385","type":"CDM"},{"code":"521","type":"RC"},{"code":"99385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":265,"gross_charge":279,"discounted_cash":251,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Tr Initial Administration Ivp Meds","code_information":[{"code":"240029","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":264,"gross_charge":278,"discounted_cash":250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Obs Initial Administration Ivp Meds","code_information":[{"code":"240070","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":264,"gross_charge":278,"discounted_cash":250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Er Initial Administration Ivp Meds","code_information":[{"code":"1090026","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":264,"gross_charge":278,"discounted_cash":250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Sirolimus Level-serum","code_information":[{"code":"4000402","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":263,"gross_charge":277,"discounted_cash":249,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229}]}]},{"description":"Xr Hand 2 Views (Lt)","code_information":[{"code":"5010042","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":228,"maximum":262,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":228}]}]},{"description":"Xr Hand 2 Views (Rt)","code_information":[{"code":"5010044","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":228,"maximum":262,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":228}]}]},{"description":"Thyroid Peroxidase Antibodies-serum","code_information":[{"code":"4000430","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":261,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Influenza H1n1 (2009) Real Time Rt Pcr","code_information":[{"code":"4000288","type":"CDM"},{"code":"300","type":"RC"},{"code":"87502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":259,"gross_charge":273,"discounted_cash":246,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Xr Bone Age Study","code_information":[{"code":"5010010","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":259,"gross_charge":273,"discounted_cash":246,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"..Zz Test T4 Free","code_information":[{"code":"919191","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":257,"gross_charge":271,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"..Zz Test Sjogrens Ab","code_information":[{"code":"919192","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":257,"gross_charge":271,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Ana Screen Ifa","code_information":[{"code":"4000026","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":257,"gross_charge":271,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Xr Shoulder 1 View (Rt)","code_information":[{"code":"5010087","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":223,"maximum":257,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Xr Shoulder 1 View (Lt)","code_information":[{"code":"5010089","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":223,"maximum":257,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Shave Lesion .6 To 1 Cm Trunk","code_information":[{"code":"8011301","type":"CDM"},{"code":"521","type":"RC"},{"code":"11301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":257,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Physical65 & Over","code_information":[{"code":"8099397","type":"CDM"},{"code":"521","type":"RC"},{"code":"99397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":257,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Airvo A/s Tube Chamber Kit 10/pk","code_information":[{"code":"2589956","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589956","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":222,"maximum":256,"gross_charge":269,"discounted_cash":242,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222}]}]},{"description":"Cast-short Arm","code_information":[{"code":"8029075","type":"CDM"},{"code":"521","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":256,"gross_charge":269,"discounted_cash":242,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222}]}]},{"description":"Xr Foot 2 Views (Lt)","code_information":[{"code":"5010036","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":221,"maximum":254,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Foot 2 Views (Rt)","code_information":[{"code":"5010038","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":221,"maximum":254,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Upper Extremity Infant Min 2 Vie (Rt)","code_information":[{"code":"5010101","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":221,"maximum":254,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Upper Extremity Infant Min 2 Vie (Lt)","code_information":[{"code":"5010109","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":221,"maximum":254,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Obs Iv Push Admin Addl Dose Same Drug","code_information":[{"code":"246411","type":"CDM"},{"code":"761","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":253,"gross_charge":266,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Tr Iv Push Admin Addl Dose Same Drug","code_information":[{"code":"246420","type":"CDM"},{"code":"761","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":253,"gross_charge":266,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Er Iv Push Admin Addl Dose Same Drug","code_information":[{"code":"1090027","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":253,"gross_charge":266,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"7599203","type":"CDM"},{"code":"940","type":"RC"},{"code":"99203","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":220,"maximum":253,"gross_charge":266,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Lyme Disease Antibod(igg Igm)immuno Blot","code_information":[{"code":"4000303","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":252,"gross_charge":265,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Xr Ankle 2 Views (Lt)","code_information":[{"code":"5010006","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":219,"maximum":252,"gross_charge":265,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Xr Ankle 2 Views (Rt)","code_information":[{"code":"5010008","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":219,"maximum":252,"gross_charge":265,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":219}]}]},{"description":"Xr Wrist 2 Views (Lt)","code_information":[{"code":"5010104","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":218,"maximum":251,"gross_charge":264,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Xr Wrist 2 Views (Rt)","code_information":[{"code":"5010106","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":218,"maximum":251,"gross_charge":264,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Physicalage 12-17","code_information":[{"code":"8099384","type":"CDM"},{"code":"521","type":"RC"},{"code":"99384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":249,"gross_charge":262,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"Quantiferon- Tb Gold","code_information":[{"code":"4000371","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":248,"gross_charge":261,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"Xr Calcaneus Minimum 2 Views (Lt)","code_information":[{"code":"5010013","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":216,"maximum":248,"gross_charge":261,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"Xr Calcaneus Minimum 2 Views (Rt)","code_information":[{"code":"5010014","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":216,"maximum":248,"gross_charge":261,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"Fracture Toe(s)","code_information":[{"code":"8028510","type":"CDM"},{"code":"521","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":269,"gross_charge":261,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":269},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"Estrogen Total Serum","code_information":[{"code":"4000192","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":247,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Xr Orbits Detection For Foreign Body","code_information":[{"code":"5010069","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":247,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Nasal Hemor Cautery","code_information":[{"code":"8030901","type":"CDM"},{"code":"521","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":247,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Mc Annual Px- Subsequent","code_information":[{"code":"8070439","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0439","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":215,"maximum":247,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Physage 40-64 Establis","code_information":[{"code":"8099396","type":"CDM"},{"code":"521","type":"RC"},{"code":"99396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":247,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Apply Long Arm Splintshoulder To Hand","code_information":[{"code":"1090006","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":246,"gross_charge":259,"discounted_cash":233,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Unna Boot","code_information":[{"code":"246412","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":245,"gross_charge":258,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Unna Boot","code_information":[{"code":"1090047","type":"CDM"},{"code":"450","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":245,"gross_charge":258,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Xr Knee Bilateral Standing Ap Only","code_information":[{"code":"5010056","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":245,"gross_charge":258,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"Benign Lesion Other <.5cm","code_information":[{"code":"8011420","type":"CDM"},{"code":"521","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":245,"gross_charge":258,"discounted_cash":232,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213}]}]},{"description":"I & D Simple Abscess","code_information":[{"code":"8010060","type":"CDM"},{"code":"521","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":244,"gross_charge":257,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":221},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Nursing Home Initial Visi","code_information":[{"code":"8319305","type":"CDM"},{"code":"525","type":"RC"},{"code":"99305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":243,"gross_charge":256,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":242},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Joint Inj. Hip Knees Shoulder","code_information":[{"code":"240079","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":242,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Extended Recovery 2 Hours","code_information":[{"code":"2300002","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2300002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":211,"maximum":242,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Copeptin","code_information":[{"code":"4000310","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":242,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Closed Treat Radial Head, Child, Nursema","code_information":[{"code":"1090061","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":240,"gross_charge":253,"discounted_cash":228,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Troponin-hs","code_information":[{"code":"4000481","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":239,"gross_charge":252,"discounted_cash":227,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":208}]}]},{"description":"Insertion Bladder Cath Temporary Tr","code_information":[{"code":"220010","type":"CDM"},{"code":"761","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":238,"gross_charge":251,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Insertion Bladder Cath Temporary Obs","code_information":[{"code":"240062","type":"CDM"},{"code":"761","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":238,"gross_charge":251,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Insertion Bladder Cath Temporary","code_information":[{"code":"1090031","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":238,"gross_charge":251,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Benign Lesion <.5cm","code_information":[{"code":"8011400","type":"CDM"},{"code":"521","type":"RC"},{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":238,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207}]}]},{"description":"Xr Fingers Minimum 2 Views (Lt)","code_information":[{"code":"5010035","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":204,"maximum":235,"gross_charge":247,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Xr Fingers Minimum 2 Views (Rt)","code_information":[{"code":"5020035","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":204,"maximum":235,"gross_charge":247,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Physical New Ptage 1-4","code_information":[{"code":"8099382","type":"CDM"},{"code":"521","type":"RC"},{"code":"99382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":235,"gross_charge":247,"discounted_cash":222,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204}]}]},{"description":"Tr  Admin Ivp Meds New Drug Add On","code_information":[{"code":"240028","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":234,"gross_charge":246,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Obs Admin Ivp Meds New Drug Add On","code_information":[{"code":"240073","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":234,"gross_charge":246,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Er Admin Ivp Meds New Drug Add On","code_information":[{"code":"1090021","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":234,"gross_charge":246,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Xr Toes Minimum 2 Views (Lt)","code_information":[{"code":"5010100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":203,"maximum":234,"gross_charge":246,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Xr Toes Minimum 2 Views (Rt)","code_information":[{"code":"5020100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":203,"maximum":234,"gross_charge":246,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Homocysteine-serum","code_information":[{"code":"4000266","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":233,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Tacrolimus Level-serum","code_information":[{"code":"4000422","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":233,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Ot Eval High Complexity","code_information":[{"code":"6297167","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":202,"maximum":233,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"I&d Of Abscess Skin, Subcutaneous","code_information":[{"code":"8010062","type":"CDM"},{"code":"521","type":"RC"},{"code":"10040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":233,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Vacpneumovax 23 Inj [0.5 Ml]","code_information":[{"code":"3000382","type":"CDM"},{"code":"250","type":"RC"},{"code":"64943","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":202,"maximum":232,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Initial Sb Stay","code_information":[{"code":"8099305","type":"CDM"},{"code":"524","type":"RC"},{"code":"99305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":242,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":242},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Ca 19-9","code_information":[{"code":"4000056","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":231,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Catecholamines Fractn W/creat 24hr Urine","code_information":[{"code":"4000071","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":231,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Catecholamines Fractionated 24-hr Urine","code_information":[{"code":"4000072","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":231,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Physage 18-39 Establis","code_information":[{"code":"8099395","type":"CDM"},{"code":"521","type":"RC"},{"code":"99395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":231,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Housevisit Standard","code_information":[{"code":"8099349","type":"CDM"},{"code":"522","type":"RC"},{"code":"99349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":240,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":240},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"H Pylori Breath Test","code_information":[{"code":"4000220","type":"CDM"},{"code":"300","type":"RC"},{"code":"83013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":227,"gross_charge":239,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198}]}]},{"description":"Igf I Lc/ms","code_information":[{"code":"4000273","type":"CDM"},{"code":"301","type":"RC"},{"code":"84305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":226,"gross_charge":238,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"Levetiracetam (Keppra) Level-serum","code_information":[{"code":"4000297","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":226,"gross_charge":238,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"Procalcitonin","code_information":[{"code":"4000318","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":226,"gross_charge":238,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":197}]}]},{"description":"Ertapenem 1 Gram Vial","code_information":[{"code":"3000217","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":196,"maximum":225,"gross_charge":237,"discounted_cash":213,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Wart Removal <16ea","code_information":[{"code":"8017110","type":"CDM"},{"code":"521","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":225,"gross_charge":237,"discounted_cash":213,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"C Diff Amplified Probe","code_information":[{"code":"4000054","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":224,"gross_charge":236,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195}]}]},{"description":"Shave Les Face .6-1.0 Cm","code_information":[{"code":"8011311","type":"CDM"},{"code":"521","type":"RC"},{"code":"11311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":224,"gross_charge":236,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195}]}]},{"description":"Physicalage 5-11","code_information":[{"code":"8099383","type":"CDM"},{"code":"521","type":"RC"},{"code":"99383","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":222,"gross_charge":234,"discounted_cash":211,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Nicotine & Cotinine C/ms/ms Serum/plasma","code_information":[{"code":"4000322","type":"CDM"},{"code":"300","type":"RC"},{"code":"80323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":221,"gross_charge":233,"discounted_cash":210,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"I & D Pilonidal Cyst, Simple","code_information":[{"code":"8090080","type":"CDM"},{"code":"521","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":229,"gross_charge":233,"discounted_cash":210,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":229},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Gentamicin Level-peak","code_information":[{"code":"4000207","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":220,"gross_charge":232,"discounted_cash":209,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Gentamicin Level-trough","code_information":[{"code":"4000208","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":220,"gross_charge":232,"discounted_cash":209,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Cardiac Clinic Level 2","code_information":[{"code":"7920025","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":220,"gross_charge":232,"discounted_cash":209,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"Dhea Sulfate","code_information":[{"code":"4000174","type":"CDM"},{"code":"300","type":"RC"},{"code":"82626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":219,"gross_charge":231,"discounted_cash":208,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Physicalage 12-17","code_information":[{"code":"8099394","type":"CDM"},{"code":"521","type":"RC"},{"code":"99394","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":219,"gross_charge":231,"discounted_cash":208,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191}]}]},{"description":"Obs Iv Therapy / Addl Drug","code_information":[{"code":"240060","type":"CDM"},{"code":"761","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Tr Iv Therapy / Addl Drug","code_information":[{"code":"246409","type":"CDM"},{"code":"761","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Er Iv Therapy / Addl Drug","code_information":[{"code":"1090028","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Xr Joint Survey Minimum 2 Joints 1 View","code_information":[{"code":"5010053","type":"CDM"},{"code":"320","type":"RC"},{"code":"77077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Crpad Rehabilitation","code_information":[{"code":"6693668","type":"CDM"},{"code":"943","type":"RC"},{"code":"93668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Cast Short Leg","code_information":[{"code":"8029405","type":"CDM"},{"code":"521","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":219,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Lacosamide","code_information":[{"code":"4000320","type":"CDM"},{"code":"300","type":"RC"},{"code":"80235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":218,"gross_charge":229,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Surgical Pathology Lesion","code_information":[{"code":"8088305","type":"CDM"},{"code":"521","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":218,"gross_charge":229,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Application Short Leg Splint","code_information":[{"code":"1090005","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":217,"gross_charge":228,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Physicalage 1-4","code_information":[{"code":"8099392","type":"CDM"},{"code":"521","type":"RC"},{"code":"99392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":217,"gross_charge":228,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Cancer Antigen 15-3 (Ca15-3)-serum","code_information":[{"code":"4000063","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":216,"gross_charge":227,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Xr Bones And Joints Stress By Physician","code_information":[{"code":"5010012","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":216,"gross_charge":227,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Removal Nail Plate","code_information":[{"code":"8011730","type":"CDM"},{"code":"521","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":216,"gross_charge":227,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Physicalage 5-11","code_information":[{"code":"8099393","type":"CDM"},{"code":"521","type":"RC"},{"code":"99393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":216,"gross_charge":227,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Cl-pneumovax 23 25mcg","code_information":[{"code":"3000102","type":"CDM"},{"code":"250","type":"RC"},{"code":"64943","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":186,"maximum":214,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pneumovax","code_information":[{"code":"8090732","type":"CDM"},{"code":"250","type":"RC"},{"code":"90732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":214,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Outpatient Visit-complex","code_information":[{"code":"8099214","type":"CDM"},{"code":"521","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":214,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Prevent Med Counsel 60 Min","code_information":[{"code":"8099404","type":"CDM"},{"code":"521","type":"RC"},{"code":"99404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":214,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":186}]}]},{"description":"Foreign Body Eye Conjunc","code_information":[{"code":"1090068","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":213,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Compatibility Test-incubation(37)phase 2","code_information":[{"code":"4000097","type":"CDM"},{"code":"300","type":"RC"},{"code":"86921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":213,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Compatibility Test-incubation(37)phase 3","code_information":[{"code":"4000098","type":"CDM"},{"code":"300","type":"RC"},{"code":"86921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":213,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Compatibility Test-incubation(37)phase 4","code_information":[{"code":"4000099","type":"CDM"},{"code":"300","type":"RC"},{"code":"86921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":213,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Compatibility Test-incubation(37)phase 1","code_information":[{"code":"4000101","type":"CDM"},{"code":"300","type":"RC"},{"code":"86921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":213,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185}]}]},{"description":"Sz 5 King Lt Endotracheal Tube Suction P","code_information":[{"code":"2589965","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589965","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":212,"gross_charge":223,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Helicobacter Pylori Stool","code_information":[{"code":"4000232","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":212,"gross_charge":223,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Ot Evaluation & Treatment","code_information":[{"code":"6297003","type":"CDM"},{"code":"434","type":"RC"},{"code":"97003","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":184,"maximum":212,"gross_charge":223,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Ot Eval Mod Complexity","code_information":[{"code":"6297166","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":184,"maximum":212,"gross_charge":223,"discounted_cash":201,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Shave Biopsy First Lesion","code_information":[{"code":"8011102","type":"CDM"},{"code":"521","type":"RC"},{"code":"11102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":211,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Alcohol Qualitative-saliva","code_information":[{"code":"4000015","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":210,"gross_charge":221,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Alcohol (Ethanol) Qualitative-blood","code_information":[{"code":"4000016","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":210,"gross_charge":221,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Drugs Of Abuse Screen Serum & Volatiles","code_information":[{"code":"4000180","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":208,"gross_charge":219,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Physinfant-1 Year","code_information":[{"code":"8099381","type":"CDM"},{"code":"521","type":"RC"},{"code":"99381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":207,"gross_charge":218,"discounted_cash":196,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Air Ankle Stirrup","code_information":[{"code":"2584061","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":206,"gross_charge":217,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Therapeutic Phlebotomy","code_information":[{"code":"4000343","type":"CDM"},{"code":"300","type":"RC"},{"code":"99195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":205,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":183},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Chiropractic, Pt Office Visit 15 Min","code_information":[{"code":"7599213","type":"CDM"},{"code":"940","type":"RC"},{"code":"99213","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":179,"maximum":205,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Lg Tracker Ex Concise Walker","code_information":[{"code":"2589817","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":204,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Med Walker Tracker(ankle)","code_information":[{"code":"2589818","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":204,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Med Walker (High)tracker Ex","code_information":[{"code":"2589845","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":204,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Sz 3 King Lt Endotracheal Tube Suction P","code_information":[{"code":"2589966","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589966","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":204,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Cr Single Pacer Evaluation","code_information":[{"code":"6693279","type":"CDM"},{"code":"480","type":"RC"},{"code":"93279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":204,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Circuit, Dbl S/bore 15mm Astral 150","code_information":[{"code":"2585025","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":203,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Optiflow+ Adult Cannula Medium 10/bx","code_information":[{"code":"2589954","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":203,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Optiflow+ Adult Cannula Large","code_information":[{"code":"2589955","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":203,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Cr Pacer Icd Evaluation Multi","code_information":[{"code":"6693284","type":"CDM"},{"code":"480","type":"RC"},{"code":"93284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":203,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Shave Les Feet .6-1.0 Cm","code_information":[{"code":"8011306","type":"CDM"},{"code":"521","type":"RC"},{"code":"11306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":203,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177}]}]},{"description":"Er- Level 1limited Er Visit","code_information":[{"code":"1090014","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":202,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pacesetter Air Walker X-large","code_information":[{"code":"2580578","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":202,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Air Walker Leg Inline Large","code_information":[{"code":"2584089","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":334,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":334},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Pacesetter Air Walker Md/lg","code_information":[{"code":"2587008","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2587008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":202,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"8099203","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":202,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Physicalnb To 1 Yr Old","code_information":[{"code":"8099391","type":"CDM"},{"code":"521","type":"RC"},{"code":"99391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":202,"gross_charge":213,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176}]}]},{"description":"Cortisol Free","code_information":[{"code":"4000109","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":200,"gross_charge":211,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Removal Foreign Body Ear Canal","code_information":[{"code":"8069200","type":"CDM"},{"code":"521","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":200,"gross_charge":211,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Introduction Of Needle Or Intracatheter","code_information":[{"code":"240024","type":"CDM"},{"code":"761","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":200,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Introduction Of Needle Or Intracatheter,","code_information":[{"code":"1090058","type":"CDM"},{"code":"450","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":200,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Sz4 King Lt Endotrachealtube Suction Por","code_information":[{"code":"2589964","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589964","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":200,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Integrilin 2mg/ml","code_information":[{"code":"3000215","type":"CDM"},{"code":"250","type":"RC"},{"code":"85117","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":174,"maximum":200,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Erythropoietin","code_information":[{"code":"4000190","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":199,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"T3 Free-serum","code_information":[{"code":"4000417","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":199,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Pt Eval Mod Complexity","code_information":[{"code":"6197162","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":171,"maximum":197,"gross_charge":207,"discounted_cash":186,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"Combitube Airway 37 Fr 4/cs","code_information":[{"code":"2587013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2587013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":196,"gross_charge":206,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Tissue Transglutaminase Ab Iga","code_information":[{"code":"4000010","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":196,"gross_charge":206,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Actin (Smooth Muscle) Antibody (Igg)","code_information":[{"code":"4000435","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":196,"gross_charge":206,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":170}]}]},{"description":"Shave Lesion .5 Cm Or Less","code_information":[{"code":"8011300","type":"CDM"},{"code":"521","type":"RC"},{"code":"11300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":195,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Unna Boot","code_information":[{"code":"8029581","type":"CDM"},{"code":"521","type":"RC"},{"code":"29581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":193,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":168}]}]},{"description":"Treatment Room 0","code_information":[{"code":"7920000","type":"CDM"},{"code":"761","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":192,"gross_charge":202,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Treatment Room 1","code_information":[{"code":"7920001","type":"CDM"},{"code":"761","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":192,"gross_charge":202,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167}]}]},{"description":"Multihance 10ml","code_information":[{"code":"2589981","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589981","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":191,"gross_charge":201,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Covid Igg (Rapid)","code_information":[{"code":"4000118","type":"CDM"},{"code":"300","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":191,"gross_charge":201,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Covid Igm (Rapid)","code_information":[{"code":"4000119","type":"CDM"},{"code":"300","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":191,"gross_charge":201,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Lyme Disease Ab W/reflex To Blot(igg Igm","code_information":[{"code":"4000302","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":191,"gross_charge":201,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Removal Of Fb From External Audio Canal","code_information":[{"code":"1090063","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":190,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"Sterile Cut Down Tray","code_information":[{"code":"2589727","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589727","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":190,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}]},{"description":"Cl-pentacel (Dtap, Ip, Hib) 6wks4 Yrs","code_information":[{"code":"3000100","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281051105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":165,"maximum":190,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Pentacel","code_information":[{"code":"8090698","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281051105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":165,"maximum":190,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cancer Antigen 125 (Ca125)-serum","code_information":[{"code":"4000062","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":188,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Drugs Of Abuse Qualitative","code_information":[{"code":"4000181","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":188,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Vancomycin Level-peak","code_information":[{"code":"4000456","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":186,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Vancomycin Trough","code_information":[{"code":"4000457","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":186,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Eia","code_information":[{"code":"4000183","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":185,"gross_charge":195,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"Ql Jc Polyoma Virus Dna, Quantitative","code_information":[{"code":"4000260","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":184,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Microbiology Culture And Typing Procedur","code_information":[{"code":"4000319","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":184,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Streptococcus Pyogenes (Group A)","code_information":[{"code":"4000354","type":"CDM"},{"code":"300","type":"RC"},{"code":"87651","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":71,"maximum":184,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Nrsg Home Visit Subsequen","code_information":[{"code":"8099309","type":"CDM"},{"code":"524","type":"RC"},{"code":"99309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":184,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"25-hydroxy-vitamin D-serum","code_information":[{"code":"4000466","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":183,"gross_charge":193,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Paring/cutting Of Corn/callus 2-4 Lesion","code_information":[{"code":"8011056","type":"CDM"},{"code":"521","type":"RC"},{"code":"11056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":183,"gross_charge":193,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Home Visit Expanded 25 Min","code_information":[{"code":"8099348","type":"CDM"},{"code":"521","type":"RC"},{"code":"99348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":182,"gross_charge":192,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159}]}]},{"description":"Advance Care Planning","code_information":[{"code":"8099497","type":"CDM"},{"code":"521","type":"RC"},{"code":"99497","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":159,"maximum":182,"gross_charge":192,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159}]}]},{"description":"G Tube Gastrostomy Tube 3-port Slip Luer","code_information":[{"code":"2589928","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589928","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":181,"gross_charge":191,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Removal Skin Tags <15","code_information":[{"code":"8011200","type":"CDM"},{"code":"521","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":181,"gross_charge":191,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":165},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"Cl-pediarix (Dtap, Hep B, Ip)0.5ml","code_information":[{"code":"3000099","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":157,"maximum":181,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vitamin A-serum","code_information":[{"code":"4000462","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":181,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Pediarix","code_information":[{"code":"8090723","type":"CDM"},{"code":"250","type":"RC"},{"code":"90723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":181,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Immunoglobulin A","code_information":[{"code":"4000280","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":180,"gross_charge":189,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Immunoglobulin Igg","code_information":[{"code":"4000281","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":180,"gross_charge":189,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Immunoglobulin Igm","code_information":[{"code":"4000321","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":180,"gross_charge":189,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156}]}]},{"description":"Prolactin Level-serum","code_information":[{"code":"4000356","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":179,"gross_charge":188,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Isovue 370 100ml","code_information":[{"code":"2589984","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":178,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Culture Viral Body Fluids Tissues","code_information":[{"code":"4000163","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":178,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Ot Eval Low Complexity","code_information":[{"code":"6297165","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":155,"maximum":178,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Complement Total","code_information":[{"code":"4000104","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"CPT","modifier":"90"}],"standard_charges":[{"setting":"outpatient","modifier_code":["90"],"minimum":154,"maximum":177,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154}]}]},{"description":"Cl-varivax (Varicella Virus Vac Live)","code_information":[{"code":"3000113","type":"CDM"},{"code":"250","type":"RC"},{"code":"64827","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":153,"maximum":176,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chicken Pox (Varicella)","code_information":[{"code":"8090716","type":"CDM"},{"code":"250","type":"RC"},{"code":"90716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":176,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Clostridium Difficile Toxin Gdh W/reflex","code_information":[{"code":"4000086","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":175,"gross_charge":184,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Impact Testing","code_information":[{"code":"8096120","type":"CDM"},{"code":"521","type":"RC"},{"code":"96120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":175,"gross_charge":184,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Bladder Irrigation Simple Lavage","code_information":[{"code":"1090059","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":174,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Amp Probe Technique Covid 19","code_information":[{"code":"4000024","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":174,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Estradiol-serum","code_information":[{"code":"4000191","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":174,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151}]}]},{"description":"Cryptosporidium","code_information":[{"code":"4000136","type":"CDM"},{"code":"300","type":"RC"},{"code":"87272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":173,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Lamotrigine (Lamictal) Level-serum","code_information":[{"code":"4000294","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":173,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Skin Biopsy","code_information":[{"code":"8011100","type":"CDM"},{"code":"521","type":"RC"},{"code":"11100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":173,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Joint Inj-shldrhipknee","code_information":[{"code":"8020610","type":"CDM"},{"code":"521","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":173,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Initial Nursing Facility Carenew Pt","code_information":[{"code":"8099304","type":"CDM"},{"code":"525","type":"RC"},{"code":"99304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":173,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Demerol 50mg","code_information":[{"code":"3000430","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":172,"gross_charge":181,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Demerol 75mg","code_information":[{"code":"3000434","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":172,"gross_charge":181,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Air Walker Small Inline Closed Heel","code_information":[{"code":"2580125","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580125","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":171,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Medical Nutrition Initial 15 Min","code_information":[{"code":"7920035","type":"CDM"},{"code":"510","type":"RC"},{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":171,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Insertion Bladder Cath Temporary","code_information":[{"code":"8051702","type":"CDM"},{"code":"521","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":171,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"Gastrin-serum","code_information":[{"code":"4000204","type":"CDM"},{"code":"300","type":"RC"},{"code":"82941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":170,"gross_charge":179,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Testosterone Free Lc/ms/ms","code_information":[{"code":"4000425","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":170,"gross_charge":179,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Tr Insertion Of Non-dwelling Bladder Cat","code_information":[{"code":"240036","type":"CDM"},{"code":"761","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":168,"gross_charge":177,"discounted_cash":159,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Insertion Of Non-indwelling Bladder Cath","code_information":[{"code":"1090032","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":168,"gross_charge":177,"discounted_cash":159,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Kidney function panel test","code_information":[{"code":"4000373","type":"CDM"},{"code":"300","type":"RC"},{"code":"80069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":168,"gross_charge":177,"discounted_cash":159,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Tr Insertion Of Non-dwelling Bladder Cat","code_information":[{"code":"7920006","type":"CDM"},{"code":"761","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":168,"gross_charge":177,"discounted_cash":159,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146}]}]},{"description":"Maxtrax Air Walker Medium","code_information":[{"code":"2584035","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":167,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Maxtrax Air Walker Large","code_information":[{"code":"2584036","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":167,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"4000105","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":167,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"D-dimer Quantitative-plasma","code_information":[{"code":"4000172","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":167,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Shaving Of Epidermal Or Dermal Lesion,1.","code_information":[{"code":"8011312","type":"CDM"},{"code":"521","type":"RC"},{"code":"11312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":174,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":174},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Port Flush","code_information":[{"code":"240063","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Er-cardiac Monit-rhythm Strip Q 15min X4","code_information":[{"code":"410011","type":"CDM"},{"code":"732","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Er- Telemetry/cardiac Monitor","code_information":[{"code":"410012","type":"CDM"},{"code":"732","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Er- Cardiac Monitor","code_information":[{"code":"410013","type":"CDM"},{"code":"732","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Rickettsia(typhus Fever)antibodies(igg I","code_information":[{"code":"4000382","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Prevent Med Counsel 45 Minutes","code_information":[{"code":"8099403","type":"CDM"},{"code":"521","type":"RC"},{"code":"99403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":166,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Nuclear Med","code_information":[{"code":"8313016","type":"CDM"},{"code":"521","type":"RC"},{"code":"93016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":165,"gross_charge":174,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Primidone","code_information":[{"code":"4000352","type":"CDM"},{"code":"300","type":"RC"},{"code":"80188","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":164,"gross_charge":173,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Chiropractic, New Pt Office Visit 20 Min","code_information":[{"code":"7599202","type":"CDM"},{"code":"940","type":"RC"},{"code":"99202","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":143,"maximum":164,"gross_charge":173,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Rotavirus Antigen Detection","code_information":[{"code":"4000384","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":163,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Pt Eval Treat","code_information":[{"code":"6197160","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":142,"maximum":163,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Pt Eval Low Complexity","code_information":[{"code":"6197161","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":142,"maximum":163,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142}]}]},{"description":"Tr Concurrent Infusion","code_information":[{"code":"240075","type":"CDM"},{"code":"761","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Obs Concurrent Infusion","code_information":[{"code":"240076","type":"CDM"},{"code":"761","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Er Concurrent Infusion","code_information":[{"code":"1090022","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Carcinoembryoric Antigen (Cea)-serum","code_information":[{"code":"4000069","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"C-peptide-serum","code_information":[{"code":"4000126","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Initial Treatment, First Degree Burn,","code_information":[{"code":"8096000","type":"CDM"},{"code":"521","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":162,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Cl-rotateq (Rotavirus Vaccine.live)","code_information":[{"code":"3000107","type":"CDM"},{"code":"250","type":"RC"},{"code":"64047","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":141,"maximum":162,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glucose Toler 3 Spec","code_information":[{"code":"4000217","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":162,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"St Louis Encephalitits Virus Antibodies(","code_information":[{"code":"4000411","type":"CDM"},{"code":"300","type":"RC"},{"code":"86653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":162,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Rotavirus Vaccine","code_information":[{"code":"8090680","type":"CDM"},{"code":"250","type":"RC"},{"code":"64047","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":141,"maximum":162,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Recovery Room 30 Minutes","code_information":[{"code":"2300003","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2300003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":161,"gross_charge":169,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Picc Line Blood Draw","code_information":[{"code":"4000345","type":"CDM"},{"code":"300","type":"RC"},{"code":"36592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":161,"gross_charge":169,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Port Draw","code_information":[{"code":"4000346","type":"CDM"},{"code":"300","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":161,"gross_charge":169,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Valproic Acid Level-serum","code_information":[{"code":"4000455","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":161,"gross_charge":169,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Application Of Finger Splint Static","code_information":[{"code":"1090004","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":160,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Cortisol Pm","code_information":[{"code":"4000111","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":160,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Cortisol Total","code_information":[{"code":"4000112","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":160,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Cortisol-serum","code_information":[{"code":"4000114","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":160,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Cortisol-serum (Am Draw)","code_information":[{"code":"4000115","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":160,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Culture Yeast W/direct Fluorescent Koh","code_information":[{"code":"4000165","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":159,"gross_charge":167,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Stone Analysis","code_information":[{"code":"4000412","type":"CDM"},{"code":"300","type":"RC"},{"code":"82365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":159,"gross_charge":167,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Helicobacter Pylori Antibodies","code_information":[{"code":"4000233","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":158,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137}]}]},{"description":"Liver function blood test","code_information":[{"code":"4000237","type":"CDM"},{"code":"300","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":157,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Salicylates Quantitative-blood","code_information":[{"code":"4000390","type":"CDM"},{"code":"300","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":157,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Vitamin C","code_information":[{"code":"4000464","type":"CDM"},{"code":"301","type":"RC"},{"code":"82180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":157,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Removal, Non-biodegradable Drug Implant","code_information":[{"code":"8011982","type":"CDM"},{"code":"521","type":"RC"},{"code":"11982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":222,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":222},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Absolute Cd4/cd8 Count With Ratio","code_information":[{"code":"4000134","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":155,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Cyclic Citrullinated Peptide (Ccp)ab(igg","code_information":[{"code":"4000169","type":"CDM"},{"code":"300","type":"RC"},{"code":"86200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":155,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Phenobarbital Level-serum","code_information":[{"code":"4000340","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":155,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Complement Component C3c","code_information":[{"code":"4000102","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":154,"gross_charge":162,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Complement Component C4c","code_information":[{"code":"4000103","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":154,"gross_charge":162,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Discharge Sb Stay","code_information":[{"code":"8099315","type":"CDM"},{"code":"525","type":"RC"},{"code":"99315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":154,"gross_charge":162,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Alpha-1-antitrypsin Quantitative-serum","code_information":[{"code":"4000019","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":153,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Leg Walker Boot","code_information":[{"code":"8074386","type":"CDM"},{"code":"521","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":203,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"T. Vaginalis Rna, Male","code_information":[{"code":"4000223","type":"CDM"},{"code":"300","type":"RC"},{"code":"87661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":152,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"M. Genitalium, Tma","code_information":[{"code":"4000224","type":"CDM"},{"code":"300","type":"RC"},{"code":"87563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":152,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Hepatitis A Antibodies Igm-serum","code_information":[{"code":"4000239","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":152,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Varicella Virus Antibod Igg(elisa)serum","code_information":[{"code":"4000458","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":152,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Remove Impacted Cerumen","code_information":[{"code":"1090040","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":151,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Testosterone-serum","code_information":[{"code":"4000426","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":151,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Testosterone Total Males","code_information":[{"code":"4000427","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":151,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Isovue 300  100ml","code_information":[{"code":"2589982","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":150,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"5-hydroxyindoleacetic Acid(5-hiaa)-urine","code_information":[{"code":"4000002","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":150,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Carboxyhemoglobin-serum","code_information":[{"code":"4000068","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":150,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Human Chorionic Gonadotrophin(hcg)(quant","code_information":[{"code":"4000271","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":150,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Xr Cholecystography With Oral Contrast","code_information":[{"code":"5010024","type":"CDM"},{"code":"320","type":"RC"},{"code":"74290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":169,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":169},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"Phenytoin Level Serum","code_information":[{"code":"4000342","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":148,"gross_charge":156,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Risperidone","code_information":[{"code":"4000383","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":148,"gross_charge":156,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Debridement Without Anestheisa","code_information":[{"code":"8097602","type":"CDM"},{"code":"521","type":"RC"},{"code":"97602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":148,"gross_charge":156,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Im Or Sq Injection Per Stick Tr","code_information":[{"code":"240027","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Admin Im Antibiotic","code_information":[{"code":"240030","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Op Med Injection","code_information":[{"code":"240031","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Obs Im Or Sq Injection Per Stick","code_information":[{"code":"240067","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Er Im Or Sq Injection Per Stick","code_information":[{"code":"1090025","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Tray Parathoracentisis Saf-t","code_information":[{"code":"2589707","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589707","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Mycoplasma Pneumoniae Antibodies(igg Igm","code_information":[{"code":"4000317","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Cardiac Clinic","code_information":[{"code":"7920026","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Orthopedic Clinic","code_information":[{"code":"7920033","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Application Of Short Leg Splint","code_information":[{"code":"8029515","type":"CDM"},{"code":"521","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":147,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Assay Of Sex Hormone","code_information":[{"code":"4000042","type":"CDM"},{"code":"301","type":"RC"},{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":146,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Progesterone Level-serum","code_information":[{"code":"4000355","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":146,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Cell Ct-flds W/ Diff","code_information":[{"code":"4000477","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":146,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":127}]}]},{"description":"Posey Bed Sensor","code_information":[{"code":"2589799","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589799","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Interject Sclerotherpy Needle","code_information":[{"code":"2589809","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Glidescope Spectrum Su S3 (Sw) 10/bx","code_information":[{"code":"2589850","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589850","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Glidescope Spectrum Su Lopro S4(sw)10/bx","code_information":[{"code":"2589854","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589854","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Ot Re-eval Est Plan Of Care","code_information":[{"code":"6297168","type":"CDM"},{"code":"430","type":"RC"},{"code":"97168","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":126,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Destruct Premlgnt Lesion","code_information":[{"code":"8017000","type":"CDM"},{"code":"521","type":"RC"},{"code":"17000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Prevent Med Counsel 30 Min","code_information":[{"code":"8099402","type":"CDM"},{"code":"521","type":"RC"},{"code":"99402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":145,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Epstein-barr Viral Capsid Antibodies Igm","code_information":[{"code":"4000187","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":144,"gross_charge":152,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"4000045","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":143,"gross_charge":151,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Outpt Visit Expand-new Pt","code_information":[{"code":"8099202","type":"CDM"},{"code":"521","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":143,"gross_charge":151,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Cl-mmr (Measles, Mumps, Rubella)","code_information":[{"code":"3000098","type":"CDM"},{"code":"250","type":"RC"},{"code":"64681","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":124,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paring/cutting Of Corn/callus","code_information":[{"code":"8011055","type":"CDM"},{"code":"521","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Joint Inj-wristelbowank","code_information":[{"code":"8020605","type":"CDM"},{"code":"521","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Telehealth Visit","code_information":[{"code":"8072025","type":"CDM"},{"code":"525","type":"RC"},{"code":"G2025","type":"HCPCS","modifier":"CS"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CS"],"minimum":124,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Mmr Vaccine","code_information":[{"code":"8090707","type":"CDM"},{"code":"250","type":"RC"},{"code":"90707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Detaild Office Visit-same","code_information":[{"code":"8099213","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":143,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Child Tetanus, Dipth, Pertussis Vacc Inj","code_information":[{"code":"3000371","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281040015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":122,"maximum":141,"gross_charge":148,"discounted_cash":133,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Electrophoresisurine","code_information":[{"code":"4000185","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":140,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Organism Id Of Wound","code_information":[{"code":"4000332","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":140,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Vitamin B12-serum","code_information":[{"code":"4000463","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":140,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Ammonia-serum","code_information":[{"code":"4000023","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":139,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Covid-19 Antigen","code_information":[{"code":"4000125","type":"CDM"},{"code":"300","type":"RC"},{"code":"87426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":139,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Folate-serum","code_information":[{"code":"4000198","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":139,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Gonorrhea Probe","code_information":[{"code":"4000215","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":139,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"West Nile Virus Igm","code_information":[{"code":"4000470","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":138,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"West Nile Virus Igg","code_information":[{"code":"4000471","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":138,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Lactic Acid-plasma","code_information":[{"code":"4000293","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":137,"gross_charge":144,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"Trigger Point Inj","code_information":[{"code":"8020550","type":"CDM"},{"code":"521","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":137,"gross_charge":144,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"High Tide Walker Large","code_information":[{"code":"2584034","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":136,"gross_charge":143,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Leg Walker Hightide Small","code_information":[{"code":"2584088","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584088","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":136,"gross_charge":143,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Racepinephrine Inh Soln 2.25%","code_information":[{"code":"3000345","type":"CDM"},{"code":"250","type":"RC"},{"code":"48759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":136,"gross_charge":143,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Pruventor Heel Off Loading Device Univ 1","code_information":[{"code":"2589906","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589906","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"17 Hydroxyprogesterone (17-ohp)","code_information":[{"code":"4000001","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Alpha Fetoprotein-serum","code_information":[{"code":"4000021","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Chlamydia Probe","code_information":[{"code":"4000083","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Digoxin Level-serum","code_information":[{"code":"4000176","type":"CDM"},{"code":"300","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Unna Boot","code_information":[{"code":"8319580","type":"CDM"},{"code":"521","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":135,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Cath Collection Urine","code_information":[{"code":"1090007","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":134,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Benzodiazepines","code_information":[{"code":"4000046","type":"CDM"},{"code":"300","type":"RC"},{"code":"80154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":134,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Glucose-6-phosphate Dehydrogenase-blood","code_information":[{"code":"4000214","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":134,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Prostate Specific Antigen Screen (Psas)","code_information":[{"code":"4000393","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":134,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Joint Inj-fingers Toes","code_information":[{"code":"8020600","type":"CDM"},{"code":"521","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":134,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Follicle Stimulat Hormone(fsh)level-serm","code_information":[{"code":"4000199","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":133,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Inj Trgr Pnt >3 Muscles","code_information":[{"code":"8020553","type":"CDM"},{"code":"521","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":133,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116}]}]},{"description":"Hot Biopsy Forceps Disposible Oval Fenes","code_information":[{"code":"2588227","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2588227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":132,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Beta-hcg Qualitative-serum","code_information":[{"code":"4000048","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":132,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"4000357","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":132,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Transferrin-serum","code_information":[{"code":"4000439","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":132,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Air Leg Boot","code_information":[{"code":"8074360","type":"CDM"},{"code":"270","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":334,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":334},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Albuterol Sulf 0.5% 5mg/ml Concentrate","code_information":[{"code":"3060739","type":"CDM"},{"code":"258","type":"RC"},{"code":"50383074120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":115,"maximum":132,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":115}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nitroglycerin 100mg/ml","code_information":[{"code":"3060741","type":"CDM"},{"code":"258","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":131,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Low Tide Walker Large","code_information":[{"code":"2584032","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":203,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"High Tide Walker Medium","code_information":[{"code":"2584033","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":203,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Low Tide Walker Medium","code_information":[{"code":"2586084","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":203,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Carbamazepine (Tegretol) Level-serum","code_information":[{"code":"4000066","type":"CDM"},{"code":"300","type":"RC"},{"code":"80156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":131,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Cr Dual Pacer Evaluation","code_information":[{"code":"6693280","type":"CDM"},{"code":"480","type":"RC"},{"code":"93280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":131,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"House Call Limited","code_information":[{"code":"8099347","type":"CDM"},{"code":"522","type":"RC"},{"code":"99347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":131,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Calcium Ionized (Free)-serum","code_information":[{"code":"4000058","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Culture Anaerobic Bacteria W/gram Stain","code_information":[{"code":"4000147","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Culture Anaerobic Culture","code_information":[{"code":"4000148","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Giardia Antigen (Elisa)-stool","code_information":[{"code":"4000211","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Ova And Parasite With Giardia Antigen","code_information":[{"code":"4000335","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Kappa/lambda Light Chains, Free W/ Ratio","code_information":[{"code":"4000374","type":"CDM"},{"code":"300","type":"RC"},{"code":"83521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Theophylline Level-serum","code_information":[{"code":"4000429","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Frgn Body Conjunctiva","code_information":[{"code":"8065210","type":"CDM"},{"code":"521","type":"RC"},{"code":"65210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Hep A Vaccine (Inactivated) Vaqta Adult","code_information":[{"code":"8079997","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP8079997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":130,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Prohance 5 Ml","code_information":[{"code":"2589979","type":"CDM"},{"code":"270","type":"RC"},{"code":"27011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":128,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Ferritin-serum","code_information":[{"code":"4000195","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":128,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Prealbumin-serum","code_information":[{"code":"4000349","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":128,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Punch Biopsy Additional","code_information":[{"code":"8011105","type":"CDM"},{"code":"521","type":"RC"},{"code":"11105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":128,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Culture Fungus Skin Hair Or Nails","code_information":[{"code":"4000152","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":127,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Influenza A & B","code_information":[{"code":"4000283","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":127,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Influenza A (Rapid)","code_information":[{"code":"4000285","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":127,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Influenza B (Rapid)","code_information":[{"code":"4000287","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":127,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Chiropractic, Pt Office Visit 10 Min","code_information":[{"code":"7599212","type":"CDM"},{"code":"940","type":"RC"},{"code":"99212","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":111,"maximum":127,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111}]}]},{"description":"Valium Vial 10mg/2ml","code_information":[{"code":"3060737","type":"CDM"},{"code":"258","type":"RC"},{"code":"69339013603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":110,"maximum":126,"gross_charge":133,"discounted_cash":120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Creatinine Clearance-24 Hour Urine","code_information":[{"code":"4000131","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":126,"gross_charge":133,"discounted_cash":120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Hepatitis B Core Ab Total","code_information":[{"code":"4000240","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":126,"gross_charge":133,"discounted_cash":120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Cl-havrix (Hep-a 1440 Elu/ml Vac) Adult","code_information":[{"code":"3000088","type":"CDM"},{"code":"250","type":"RC"},{"code":"49999041201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":109,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":1440,"type":"EA"}},{"description":"Cl-hepatitis A Vaccine (Vaqta)","code_information":[{"code":"3000118","type":"CDM"},{"code":"250","type":"RC"},{"code":"64096","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":109,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Antibody Screen Immediate Spin Phase","code_information":[{"code":"4000029","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Hepatitis A Ab Total","code_information":[{"code":"4000238","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Hepatitis B Core Igm Antibody","code_information":[{"code":"4000241","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Hepatitis C Antibody","code_information":[{"code":"4000248","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Sensitivity Studiesmic","code_information":[{"code":"4000397","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Unna Boot","code_information":[{"code":"8029580","type":"CDM"},{"code":"270","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Hep A Vac 19yo Plus","code_information":[{"code":"8080632","type":"CDM"},{"code":"250","type":"RC"},{"code":"90632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Hepatitis A (Adult) 1440el.u/ml","code_information":[{"code":"8090632","type":"CDM"},{"code":"250","type":"RC"},{"code":"90632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":125,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nrsg Home Visit Subsequen","code_information":[{"code":"8099308","type":"CDM"},{"code":"525","type":"RC"},{"code":"99308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":128,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":128},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Culture Sputum/lower Respiratory","code_information":[{"code":"4000142","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Culture Genital","code_information":[{"code":"4000146","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Culture Sputum Lower Respiratory","code_information":[{"code":"4000153","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Culture Throat","code_information":[{"code":"4000158","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Culture Aerobic Bacteria","code_information":[{"code":"4000160","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Blood test, lipids","code_information":[{"code":"4000299","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":124,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Cl-hepatitis B Vacc 20mcg/ml (Engerix-b)","code_information":[{"code":"3000119","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Multi-vit Adult Vits For Inf 10ml","code_information":[{"code":"3000280","type":"CDM"},{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Culture Id-fungus","code_information":[{"code":"4000141","type":"CDM"},{"code":"300","type":"RC"},{"code":"87107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Culturefungi","code_information":[{"code":"4000166","type":"CDM"},{"code":"300","type":"RC"},{"code":"87106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Haptoglobin-serum","code_information":[{"code":"4000222","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Hepatitis B Surface Antibody Qualitative","code_information":[{"code":"4000245","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"4000431","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Mc Face To Face Counsel Obesity","code_information":[{"code":"8070447","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Prevent Med Counseling 15 Min","code_information":[{"code":"8099401","type":"CDM"},{"code":"521","type":"RC"},{"code":"99401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":124,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Extended Recovery 1 Hour","code_information":[{"code":"2300001","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP2300001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":123,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Luteinizing Hormone (Lh)-serum","code_information":[{"code":"4000301","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":123,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Ankle Walker Maxtraxx Small (Replaces 11","code_information":[{"code":"2584090","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584090","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":122,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Lg Maxtrax Ankle Walker","code_information":[{"code":"2589716","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589716","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":122,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Electrolyte Panel-serum","code_information":[{"code":"4000184","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":122,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Vitamin B1","code_information":[{"code":"4000461","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":122,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Chiropractic Manipulative Tx 5+ Regions","code_information":[{"code":"7598942","type":"CDM"},{"code":"940","type":"RC"},{"code":"98942","type":"CPT","modifier":"AT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AT"],"minimum":106,"maximum":122,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Large Amplifeye (Surgical)","code_information":[{"code":"2210020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2210020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":121,"gross_charge":127,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Posey Chair Pad Sensor 30 Day","code_information":[{"code":"2589800","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589800","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":121,"gross_charge":127,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Thyroglobulin Antibodies","code_information":[{"code":"4000038","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":121,"gross_charge":127,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Maxtrax Walker X-large","code_information":[{"code":"2584030","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":120,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Walker High Tracker X-large","code_information":[{"code":"2585026","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":120,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Cardio Insulin","code_information":[{"code":"4000289","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":120,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Insulin","code_information":[{"code":"4000311","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":120,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Protein Electrophoresis Panel-serum","code_information":[{"code":"4000366","type":"CDM"},{"code":"300","type":"RC"},{"code":"84165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":120,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Culture Stool Sal/shig/campy&shiga Refle","code_information":[{"code":"4000156","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":119,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Inj Trgr Pnt 1-2 Muscles","code_information":[{"code":"8020552","type":"CDM"},{"code":"521","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":119,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Arterial Blood Draw","code_information":[{"code":"4000040","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":118,"gross_charge":124,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Cryptosporidium","code_information":[{"code":"4000137","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":118,"gross_charge":124,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Lipase-serum","code_information":[{"code":"4000298","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":118,"gross_charge":124,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"T3 Total-serum","code_information":[{"code":"4000418","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":118,"gross_charge":124,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Pt Re-eval Est Plan Of Care","code_information":[{"code":"6197164","type":"CDM"},{"code":"420","type":"RC"},{"code":"97164","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":102,"maximum":118,"gross_charge":124,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Mycoplasma Pneumonia","code_information":[{"code":"4000316","type":"CDM"},{"code":"300","type":"RC"},{"code":"87581","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":102,"maximum":117,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Measles (Rubeola) Antibodies Igg-serum","code_information":[{"code":"4000389","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":117,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Sensitivity Studiesdisk","code_information":[{"code":"4000396","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":117,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Medical Nutrition 15 Min","code_information":[{"code":"7920036","type":"CDM"},{"code":"510","type":"RC"},{"code":"97803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":117,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Hiv Antibody Screen Hiv 1/2","code_information":[{"code":"4000258","type":"CDM"},{"code":"300","type":"RC"},{"code":"86703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":116,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Debridement Ulcer 10% Body Surface","code_information":[{"code":"8011000","type":"CDM"},{"code":"521","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":116,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Frgn Body Eye Conjunc","code_information":[{"code":"8065205","type":"CDM"},{"code":"521","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":116,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Knee Imm 24  Uni Foam","code_information":[{"code":"2589778","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589778","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":115,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Quantitative Cell Count","code_information":[{"code":"4000117","type":"CDM"},{"code":"300","type":"RC"},{"code":"86355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":115,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Qualitative Or Semiquantitative Immunoas","code_information":[{"code":"4000127","type":"CDM"},{"code":"300","type":"RC"},{"code":"86359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":115,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Dna/rna Direct Probe","code_information":[{"code":"4000333","type":"CDM"},{"code":"300","type":"RC"},{"code":"87149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":115,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Levetiraetam (Keppra) 500mg Inj","code_information":[{"code":"3000240","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":99,"maximum":114,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Mumps Igg Titer-serum","code_information":[{"code":"4000314","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":114,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Application Long Leg Splint","code_information":[{"code":"8029505","type":"CDM"},{"code":"521","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":114,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":114},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Removal Additional Nail Plate Each","code_information":[{"code":"1090037","type":"CDM"},{"code":"450","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Morgan Eye Flow Lens","code_information":[{"code":"2589736","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589736","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":112,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Each Additional Shave Biopsy","code_information":[{"code":"8011103","type":"CDM"},{"code":"521","type":"RC"},{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":112,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Steris Endoscopic Marker","code_information":[{"code":"2585028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":111,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Spot Endoscopic Marker","code_information":[{"code":"2589810","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":111,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Multihance 5ml","code_information":[{"code":"2589980","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589980","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":111,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Microalbumin (Ql)","code_information":[{"code":"4000307","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":110,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Cl-kinrix (Dtap, Ip) 4-6 Yrs 0.5ml","code_information":[{"code":"3000095","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":95,"maximum":109,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Kinrix","code_information":[{"code":"8090696","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":95,"maximum":109,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cladult Adacel (Tdap)0.5ml","code_information":[{"code":"3000071","type":"CDM"},{"code":"636","type":"RC"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ceruloplasmin-serum","code_information":[{"code":"4000078","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Urine Osmolality Random","code_information":[{"code":"4000453","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Pt Iontophoresis","code_information":[{"code":"6197033","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Pta Iontophoresis","code_information":[{"code":"6197034","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Pt Aquatics","code_information":[{"code":"6197113","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Pta Aquatics","code_information":[{"code":"6197114","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Ot Iontophoresis","code_information":[{"code":"6297033","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Ot Aquatic Therapy","code_information":[{"code":"6297113","type":"CDM"},{"code":"430","type":"RC"},{"code":"97113","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Ota Iontophoresis","code_information":[{"code":"6297171","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Ota Aquatic Therapy","code_information":[{"code":"6297175","type":"CDM"},{"code":"430","type":"RC"},{"code":"97113","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}]},{"description":"Adacel 7-65+","code_information":[{"code":"8090715","type":"CDM"},{"code":"636","type":"RC"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":108,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":7,"type":"EA"}},{"description":"Adult Resuscitator Bag W/mask","code_information":[{"code":"2586045","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":107,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Aldolase","code_information":[{"code":"4000017","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":107,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Hiv-1","code_information":[{"code":"4000474","type":"CDM"},{"code":"300","type":"RC"},{"code":"86701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":107,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Heimich Chest Drainage Valve","code_information":[{"code":"2589873","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Cl-hepatitis B Adult Vaccine 10mcg","code_information":[{"code":"3000090","type":"CDM"},{"code":"250","type":"RC"},{"code":"54569531100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":93,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"4000075","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Olanzapine","code_information":[{"code":"4000305","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Finger Splint","code_information":[{"code":"8029130","type":"CDM"},{"code":"270","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Ankle Stablizer","code_information":[{"code":"8071902","type":"CDM"},{"code":"521","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":106,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Presumptive Id","code_information":[{"code":"4000351","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":105,"gross_charge":111,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Assay Of Blood Osmolality","code_information":[{"code":"4000428","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":105,"gross_charge":111,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Oval 8 Finger Splint Combo Pack Sz 3-7","code_information":[{"code":"2584048","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Oval 8 Finger Splint Combo Pack Sz 6-10","code_information":[{"code":"2584049","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584049","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Oval 8 Finger Splint Combo Pack Sz 10-14","code_information":[{"code":"2584050","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"C-reactive Protein-serum","code_information":[{"code":"4000128","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Hep B Surface Antigen W/reflex Confirm","code_information":[{"code":"4000246","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Ql Hiv-1/2 Antigen & Antibodies 4th Gen","code_information":[{"code":"4000255","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Hepatitis B Surface Antigen","code_information":[{"code":"4000259","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Oxycodone And Metabolite Quantitative","code_information":[{"code":"4000337","type":"CDM"},{"code":"300","type":"RC"},{"code":"83925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":105,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Unlisted Procedure Abdomen Peritoneum","code_information":[{"code":"1090046","type":"CDM"},{"code":"450","type":"RC"},{"code":"49999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":104,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Creatine Kinase","code_information":[{"code":"4000129","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":104,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Hiv-2","code_information":[{"code":"4000475","type":"CDM"},{"code":"300","type":"RC"},{"code":"86702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":104,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Compression Stocking Larg","code_information":[{"code":"8076535","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":104,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Chlamydia Culture","code_information":[{"code":"4000080","type":"CDM"},{"code":"301","type":"RC"},{"code":"87110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Culture Campylobacter","code_information":[{"code":"4000151","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Pt Manual Therapy","code_information":[{"code":"6197140","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":89,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Pta Manual Therapy","code_information":[{"code":"6197141","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":89,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Ot Manual Therapy","code_information":[{"code":"6297140","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":89,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Ota Manual Therapy","code_information":[{"code":"6297177","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":89,"maximum":103,"gross_charge":108,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"King Vision Standard Blades #3","code_information":[{"code":"2586513","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Glutamic Acid Decarboxylase-65 Antibody","code_information":[{"code":"4000033","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"T4 Free-serum","code_information":[{"code":"4000420","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Remove Impacted Cerumen","code_information":[{"code":"8069210","type":"CDM"},{"code":"521","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Allevyn Dressing","code_information":[{"code":"8076212","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Chlamydia//gc","code_information":[{"code":"8087491","type":"CDM"},{"code":"521","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":102,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Large Tracker Walker","code_information":[{"code":"2589783","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589783","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"20  Foam Univ Knee Imm","code_information":[{"code":"2589801","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589801","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Cl-ipol (Poliovirus) 0.5ml","code_information":[{"code":"3000093","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281086010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Anti-streptolysin O","code_information":[{"code":"4000037","type":"CDM"},{"code":"300","type":"RC"},{"code":"86060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"4000039","type":"CDM"},{"code":"300","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Drain Blood From Under Nail","code_information":[{"code":"8011740","type":"CDM"},{"code":"521","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Knee Immobilizer","code_information":[{"code":"8071830","type":"CDM"},{"code":"521","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Poliovirus Vaccine (Ivp)","code_information":[{"code":"8090713","type":"CDM"},{"code":"250","type":"RC"},{"code":"90713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":101,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Igf Binding Protein","code_information":[{"code":"4000274","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":100,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Hospital Visit Focused","code_information":[{"code":"8319231","type":"CDM"},{"code":"521","type":"RC"},{"code":"99231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":100,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Ova &Parasites-stool","code_information":[{"code":"4000334","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":99,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Lhi1042 Pha","code_information":[{"code":"8099201","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP8099201","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":99,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Xl Consise Low Walker","code_information":[{"code":"2589717","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589717","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":98,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Ota Adl Training","code_information":[{"code":"6297179","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":85,"maximum":98,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Ot Adl Training","code_information":[{"code":"6297535","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":85,"maximum":98,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Phila Collar W/ Trach Med 4 25","code_information":[{"code":"2580134","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Phila Collar Med 3 25  W/ Trach","code_information":[{"code":"2580135","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Amylase","code_information":[{"code":"4000025","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Culture Id","code_information":[{"code":"4000140","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Herpes Simplex Type 1","code_information":[{"code":"4000250","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Pt Functional Activities","code_information":[{"code":"6197530","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Pta Functional Activities","code_information":[{"code":"6197531","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Ota Therapeutic Activities","code_information":[{"code":"6297178","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Ot Therapeutic Activities","code_information":[{"code":"6297530","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":84,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Podiatry Clinic Level 2","code_information":[{"code":"7920022","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Orthopedic Clinic Level 1","code_information":[{"code":"7920028","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Dermatology Clinic","code_information":[{"code":"7920029","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Removal 2nd Nail Plate","code_information":[{"code":"8011732","type":"CDM"},{"code":"521","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Nrs Home Visit Subsequent","code_information":[{"code":"8319307","type":"CDM"},{"code":"524","type":"RC"},{"code":"99307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":97,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Cl-tetanus And Diptheria Toxoidstd","code_information":[{"code":"3000110","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tetanus . Diptheria Vaccine- Td","code_information":[{"code":"3000370","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlamydia Pneumonia","code_information":[{"code":"4000082","type":"CDM"},{"code":"300","type":"RC"},{"code":"87486","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":83,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Culture Urine Routine","code_information":[{"code":"4000162","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Lithium Level-serum","code_information":[{"code":"4000300","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"O&p Special Stain","code_information":[{"code":"4000323","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":96,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Cl-hepatitis B Recombinant Energix-b","code_information":[{"code":"3000091","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardene Iv Ip 20mg/200ml","code_information":[{"code":"3000444","type":"CDM"},{"code":"636","type":"RC"},{"code":"43066000910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Venofer Inj [20 Mg/ Ml]","code_information":[{"code":"3000445","type":"CDM"},{"code":"636","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Shiga Toxins","code_information":[{"code":"4000400","type":"CDM"},{"code":"300","type":"RC"},{"code":"87427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Shiga Toxins Eia W/rflx To E Coli 0157 C","code_information":[{"code":"4000401","type":"CDM"},{"code":"300","type":"RC"},{"code":"87427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Hep B 19 Yrs Up","code_information":[{"code":"8090746","type":"CDM"},{"code":"250","type":"RC"},{"code":"90746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":95,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Air Splint Left Med (Replaces L1906)","code_information":[{"code":"2586729","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586729","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Small Consise Walker(low)","code_information":[{"code":"2589715","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":203,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":203},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Covid 19 (Rapid)","code_information":[{"code":"4000116","type":"CDM"},{"code":"300","type":"RC"},{"code":"87811","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":69,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Herpes Simplex/varicella Zoster Rapid Cu","code_information":[{"code":"4000252","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6197109","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":82,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6197110","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":82,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6297110","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":82,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"6297173","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":82,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Expanded Visit-same Day","code_information":[{"code":"8099212","type":"CDM"},{"code":"521","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":94,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Foam Knee Imm 16  Univ","code_information":[{"code":"2589762","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589762","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":93,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Rubella Immune Status","code_information":[{"code":"4000388","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":93,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Virus Inoculation Shell","code_information":[{"code":"4000476","type":"CDM"},{"code":"306","type":"RC"},{"code":"87254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":93,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Chiropractic Manipulative Tx 3-4 Regions","code_information":[{"code":"7598941","type":"CDM"},{"code":"940","type":"RC"},{"code":"98941","type":"CPT","modifier":"AT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AT"],"minimum":81,"maximum":93,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Pmc Drug Screeingi Urine Cup","code_information":[{"code":"8080305","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":93,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Ankle Support Aso Xl","code_information":[{"code":"2580523","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Ankle Support Aso Med","code_information":[{"code":"2580526","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580526","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Ankle Support Aso Large","code_information":[{"code":"2586058","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":145,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Cl-havrix(hep-a 720 El.u/0.5ml) Ped/adol","code_information":[{"code":"3000089","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Depo-medrol Inj 80 Mg/ml","code_information":[{"code":"3000135","type":"CDM"},{"code":"636","type":"RC"},{"code":"93475","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Acylcarnitines Quantitative Each","code_information":[{"code":"4000012","type":"CDM"},{"code":"300","type":"RC"},{"code":"82017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Insulin Autoantibody","code_information":[{"code":"4000341","type":"CDM"},{"code":"300","type":"RC"},{"code":"86337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Cr Icm/ilr Interrogation","code_information":[{"code":"6693291","type":"CDM"},{"code":"480","type":"RC"},{"code":"93291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Foam Knee Imm 16  Univ","code_information":[{"code":"8079998","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP8079998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Subsq Sb Stay","code_information":[{"code":"8099307","type":"CDM"},{"code":"525","type":"RC"},{"code":"99307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":92,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Lead Blood","code_information":[{"code":"4000296","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":91,"gross_charge":96,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Magnesium","code_information":[{"code":"4000304","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":91,"gross_charge":96,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Large High Walker Concise","code_information":[{"code":"2589856","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589856","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":90,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Iron Dextran Inj [50 Mg/2 Ml]","code_information":[{"code":"3000218","type":"CDM"},{"code":"636","type":"RC"},{"code":"23608","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":79,"maximum":90,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Inslantus 100u/ml Solostar Pen","code_information":[{"code":"3000213","type":"CDM"},{"code":"250","type":"RC"},{"code":"88221","type":"CPT","modifier":"905"}],"standard_charges":[{"setting":"outpatient","modifier_code":["905"],"minimum":78,"maximum":89,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Beta-hcg Qualitative-urine","code_information":[{"code":"4000049","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Strep A Screen","code_information":[{"code":"4000413","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Pta Neuromuscular Re-education","code_information":[{"code":"6197111","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":77,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Pt Neuromuscular Re-education","code_information":[{"code":"6197112","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":77,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Ot Neuromuscular Re-ed","code_information":[{"code":"6297112","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":77,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Ota Neuromuscular Re-ed","code_information":[{"code":"6297174","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":77,"maximum":88,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Gamma Glutamyl Transferase (Ggt)","code_information":[{"code":"4000203","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":87,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76}]}]},{"description":"Epinephrine Inj Syr [1 Mg/10 Ml]","code_information":[{"code":"3000162","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":86,"gross_charge":91,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Herpes Simplex Type 2","code_information":[{"code":"4000251","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":86,"gross_charge":91,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Ankle Brace Lace-up Nylon Xlg","code_information":[{"code":"2580577","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580577","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Pathologist Review Of Peripheral Smear","code_information":[{"code":"4000339","type":"CDM"},{"code":"300","type":"RC"},{"code":"85060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Reticulocyte Count","code_information":[{"code":"4000378","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Complete blood cell count (CBC), automated","code_information":[{"code":"4000473","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Pt Gait Training","code_information":[{"code":"6197116","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":74,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Pta Gait Training","code_information":[{"code":"6197117","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":74,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Rotatable Medium Oval Snare 10/bx","code_information":[{"code":"2589848","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589848","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Hemoglobin A1c-blood","code_information":[{"code":"4000236","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Iron Tibc","code_information":[{"code":"4000291","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filterline H Set Long Ad/ped Co2","code_information":[{"code":"2589755","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589755","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Colonoscopy Anesthesia Per Unit","code_information":[{"code":"2820010","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"812","type":"DRG","modifier":"QX"}],"standard_charges":[{"setting":"inpatient","modifier_code":["QX"],"minimum":84,"maximum":22102,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20997}]}]},{"description":"Egd Anesthesia Per Unit","code_information":[{"code":"2820014","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"731","type":"DRG","modifier":"QX"}],"standard_charges":[{"setting":"inpatient","modifier_code":["QX"],"minimum":84,"maximum":22102,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20997}]}]},{"description":"Fecal Leukocyte Stain","code_information":[{"code":"4000467","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Application Of Short Arm; Static","code_information":[{"code":"8029125","type":"CDM"},{"code":"521","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":88,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73}]}]},{"description":"Captivator Cold Single Use Snare","code_information":[{"code":"2589935","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589935","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":83,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Immunoglobulin Ige","code_information":[{"code":"4000331","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":83,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Ted Stocking Thigh Xl Reg L/f 2/pk 6pk/c","code_information":[{"code":"2584065","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"18fr Surestep Foley Tray","code_information":[{"code":"2589970","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589970","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Crystals Fluid","code_information":[{"code":"4000138","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Epstein-barr Virus Screen(monospot)serum","code_information":[{"code":"4000188","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Heterophile Mono Screen","code_information":[{"code":"4000253","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Digital Rectal Exam Medicare","code_information":[{"code":"8070102","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":82,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Cl Counseling For Lung Cancer Screening","code_information":[{"code":"8070296","type":"CDM"},{"code":"521","type":"RC"},{"code":"71271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":306,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":306},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Ankle Brace Lace Up Xs","code_information":[{"code":"2580522","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580522","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Ankle Brace Lace Up Xl","code_information":[{"code":"2580525","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Ankle Brace Lace-up Nylon Med","code_information":[{"code":"2580562","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580562","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Ankle Brace Lace-up Nylon Lgg","code_information":[{"code":"2580576","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580576","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Ankle Brace Lace-up Nylon Sml","code_information":[{"code":"2586057","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Capnoline+ Co2 Lg O2 Female Adu/int","code_information":[{"code":"2589756","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589756","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Anesthesia Upper/lower Combined","code_information":[{"code":"2820016","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"813","type":"DRG","modifier":"QX"}],"standard_charges":[{"setting":"inpatient","modifier_code":["QX"],"minimum":81,"maximum":22102,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20997},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20997}]}]},{"description":"Fungal Stain","code_information":[{"code":"4000008","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Er Oxygen","code_information":[{"code":"6700021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":81,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"16fr Foley Cath Tray Surestrep","code_information":[{"code":"2589960","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589960","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":80,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Succinylcholine Inj [20 Mg/ml]","code_information":[{"code":"3000361","type":"CDM"},{"code":"250","type":"RC"},{"code":"40966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":80,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ankle Splint Rice Large","code_information":[{"code":"2580524","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":79,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Total Cholesterol","code_information":[{"code":"4000437","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":79,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Telemedicine","code_information":[{"code":"7923014","type":"CDM"},{"code":"510","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":79,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Creatinine Other","code_information":[{"code":"4000133","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"T4 Total Serum","code_information":[{"code":"4000421","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 12l/min Non Rebreather","code_information":[{"code":"6700002","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 13l/min Non Rebreather","code_information":[{"code":"6700003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 14l/min Non Rebreather","code_information":[{"code":"6700004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 11l/min Non Rebreather","code_information":[{"code":"6700005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 5l/min Nc","code_information":[{"code":"6700006","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 9l/min Simple Mask","code_information":[{"code":"6700007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er- O2 @ 3 L/min Per Nc","code_information":[{"code":"6700008","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er- O2 @ 5 L/min Per Mask","code_information":[{"code":"6700009","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 15l/min Non Rebreather","code_information":[{"code":"6700010","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 3l/min Nc","code_information":[{"code":"6700011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 2l/min Nc","code_information":[{"code":"6700012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 7l/min Simple Mask","code_information":[{"code":"6700013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er- O2 @ 4 L/min Per Nc","code_information":[{"code":"6700014","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er- O2 @ 6 L/min Per Mask","code_information":[{"code":"6700015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 1l/min Nc","code_information":[{"code":"6700016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 4l/min Nc","code_information":[{"code":"6700017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 6l/min Simple Mask","code_information":[{"code":"6700018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er O2 @ 8l/min Simple Mask","code_information":[{"code":"6700019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Er- O2 Per Non-rebreather Mask","code_information":[{"code":"6700020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Pap Pathology","code_information":[{"code":"8088142","type":"CDM"},{"code":"521","type":"RC"},{"code":"88142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Prolonged Office Visit 15 Minutes","code_information":[{"code":"8099417","type":"CDM"},{"code":"521","type":"RC"},{"code":"99417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":78,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Sensations Medium Oval Snare","code_information":[{"code":"2586709","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":77,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Epstein-barr Virus Nuclear Antigen Antib","code_information":[{"code":"4000196","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":77,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Ldh","code_information":[{"code":"4000295","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":77,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Dhe 45 1 Mg","code_information":[{"code":"8071110","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":77,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cast Shoe","code_information":[{"code":"8073257","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":77,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Admin Vaccine","code_information":[{"code":"240026","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Admin Vaccine","code_information":[{"code":"1090001","type":"CDM"},{"code":"450","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Knee Immobilizer 24  Univ(replaces 79-80","code_information":[{"code":"2580517","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580517","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Rapid Rhino 4.5cm Inflatable Tamponade","code_information":[{"code":"2585050","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Rhino Rocket Wideline Medium 1x1 5x2 8/b","code_information":[{"code":"2589862","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589862","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Enoxaparin  300 Mg/3ml","code_information":[{"code":"3000159","type":"CDM"},{"code":"636","type":"RC"},{"code":"75062","type":"CPT","modifier":"603"}],"standard_charges":[{"setting":"outpatient","modifier_code":["603"],"minimum":66,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Phosphorus","code_information":[{"code":"4000344","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Podiatry Clinic","code_information":[{"code":"7920027","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Pap Pat Review","code_information":[{"code":"8088141","type":"CDM"},{"code":"521","type":"RC"},{"code":"88141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":76,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Remove Impacted Cerumen Irrigate/lavage","code_information":[{"code":"1090066","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Abduction Pillow Small 5/cs","code_information":[{"code":"2580038","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Isovue 300  30ml","code_information":[{"code":"2585024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"12fr Feeding Tube","code_information":[{"code":"2589750","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589750","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Cl-vitamin K 10mg","code_information":[{"code":"3000114","type":"CDM"},{"code":"250","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mannitol 20%  Solution 500ml Bag","code_information":[{"code":"3000257","type":"CDM"},{"code":"636","type":"RC"},{"code":"99077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Pt Mechanical Traction","code_information":[{"code":"6197012","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pta Mechanical Traction","code_information":[{"code":"6197013","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pta Estim/ultrasound","code_information":[{"code":"6197031","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pt Estim/ultrasound","code_information":[{"code":"6197032","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pt Ultrasound","code_information":[{"code":"6197035","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pta Ultrasound","code_information":[{"code":"6197036","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Ot Estim/ultrasound","code_information":[{"code":"6297032","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Ot Ultrasound","code_information":[{"code":"6297035","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Ota Ultrasound","code_information":[{"code":"6297172","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":65,"maximum":75,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Pt Electrical Stimulation","code_information":[{"code":"610283","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Pta Electrical Stimulation","code_information":[{"code":"610284","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Rapid Rhino 5.5cm Inflatable Tamponade","code_information":[{"code":"2585047","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Rapid Rhino 7.5cm Inflatable Tamponade","code_information":[{"code":"2585048","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Rapid Rhino 9 Cm  Dualinflat. Tamponade","code_information":[{"code":"2585049","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585049","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Rhino Rocket Large Wideline 8/bx","code_information":[{"code":"2589863","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589863","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":".Manual Diff Charge","code_information":[{"code":"4000051","type":"CDM"},{"code":"300","type":"RC"},{"code":"85007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Culture Id Agglut","code_information":[{"code":"4000154","type":"CDM"},{"code":"300","type":"RC"},{"code":"87147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Ot Electrical Stimulation","code_information":[{"code":"6297083","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Ota Electrical Stimulation","code_information":[{"code":"6297084","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":64,"maximum":74,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Levofloxacin/ D5w [750 Mg/150 Ml]","code_information":[{"code":"3000242","type":"CDM"},{"code":"636","type":"RC"},{"code":"40944","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":73,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Terbinafine 1% Antifungal Cream","code_information":[{"code":"3000368","type":"CDM"},{"code":"250","type":"RC"},{"code":"67810","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":64,"maximum":73,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toxoplasma Ab (Igg)","code_information":[{"code":"4000193","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":73,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Tenivac 7 Yo To 65+","code_information":[{"code":"8090714","type":"CDM"},{"code":"250","type":"RC"},{"code":"90714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":73,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Eosinophils-urine Sediment","code_information":[{"code":"4000186","type":"CDM"},{"code":"300","type":"RC"},{"code":"85999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":72,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Protein Total 24-hr Urine W/o Creatinine","code_information":[{"code":"4000364","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":72,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Protein Total-urine","code_information":[{"code":"4000365","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":72,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Rh (D) Typing","code_information":[{"code":"4000379","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":72,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Cl-flublok 0.5ml","code_information":[{"code":"3000082","type":"CDM"},{"code":"636","type":"RC"},{"code":"49281072110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cl-fluzone 6 Mo64 Yr","code_information":[{"code":"3000083","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281042550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Cl-fluzone High Dose (Flu Vac High Dose)","code_information":[{"code":"3000084","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cl-fluzone Pediatric (Flu Vac Quad Pedi)","code_information":[{"code":"3000085","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281011325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flublok Quadrivalent Syr 0.5ml","code_information":[{"code":"3000175","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281072110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluconazole 200mg In 100 Ml Ns","code_information":[{"code":"3000176","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fluzone High Dose","code_information":[{"code":"3000180","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluzone Quadrivalent","code_information":[{"code":"3000181","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281042150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Abo Blood Type-blood","code_information":[{"code":"4000004","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Remove Impacted Cerumen Irrigate/lavage","code_information":[{"code":"8069209","type":"CDM"},{"code":"521","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Abdominal Binder","code_information":[{"code":"8070625","type":"CDM"},{"code":"521","type":"RC"},{"code":"L0625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Shoulder Immobilizer","code_information":[{"code":"8073650","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":83,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Influenza 6 Mo To 35 Mos","code_information":[{"code":"8090655","type":"CDM"},{"code":"250","type":"RC"},{"code":"90655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fluzone 6 Mo64yr","code_information":[{"code":"8090656","type":"CDM"},{"code":"250","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Influenza Vaccine","code_information":[{"code":"8090658","type":"CDM"},{"code":"250","type":"RC"},{"code":"90658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fluzone High Dose 65+","code_information":[{"code":"8090662","type":"CDM"},{"code":"250","type":"RC"},{"code":"90662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":88,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Flublok Quadrivalent 18 To 64","code_information":[{"code":"8090682","type":"CDM"},{"code":"636","type":"RC"},{"code":"90682","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":88,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":88},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":65}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fluzone Pediatric","code_information":[{"code":"8090685","type":"CDM"},{"code":"636","type":"RC"},{"code":"90685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":65}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fluzone 6mo17yrs","code_information":[{"code":"8090686","type":"CDM"},{"code":"636","type":"RC"},{"code":"90686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":71,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":65}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Albumin 25% 50ml","code_information":[{"code":"3000014","type":"CDM"},{"code":"258","type":"RC"},{"code":"94404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":70,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Iron-serum","code_information":[{"code":"4000292","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":70,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Q-fever Ab (Igg Igm)-serum","code_information":[{"code":"4000368","type":"CDM"},{"code":"300","type":"RC"},{"code":"86638","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":70,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Rheumatoid Factor Quantitative-serum","code_information":[{"code":"4000381","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":70,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Ast","code_information":[{"code":"4000398","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":70,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Cl-infanrix (Dtap 6 Wks-6 Yrs)","code_information":[{"code":"3000092","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":69,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Piper/ Tazo Inj[3.375 Gm]","code_information":[{"code":"3000322","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":69,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Pmc Covid19","code_information":[{"code":"8087811","type":"CDM"},{"code":"300","type":"RC"},{"code":"87811","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":60,"maximum":69,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Dtap/infanrix","code_information":[{"code":"8090700","type":"CDM"},{"code":"250","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":69,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Abd Binder Adjustable 12  46 -62","code_information":[{"code":"2584097","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"18  Bariatric Knee Immobilizer","code_information":[{"code":"2589907","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589907","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"16 Fr Cath Tray Complete Care","code_information":[{"code":"2589931","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Dna(ds) Antibody","code_information":[{"code":"4000027","type":"CDM"},{"code":"300","type":"RC"},{"code":"86225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Gluc Tol-each Addition","code_information":[{"code":"4000212","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Ota Money Management","code_information":[{"code":"6297180","type":"CDM"},{"code":"430","type":"RC"},{"code":"97537","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":60,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Ot Money Management","code_information":[{"code":"6297537","type":"CDM"},{"code":"430","type":"RC"},{"code":"97537","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":60,"maximum":68,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Albuterol Sulfate Inhaler 90mcg","code_information":[{"code":"3000017","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993001968","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":59,"maximum":67,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Crutches Youth Alm W/ Acc 8/bx","code_information":[{"code":"2580504","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Crutches Alm M-adlt/w/acc","code_information":[{"code":"2584004","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Crutches Alm T-adlt/w/acc","code_information":[{"code":"2586249","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586249","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Alt","code_information":[{"code":"4000399","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Pt Massage Therapy","code_information":[{"code":"6197124","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Pta Massage Therapy","code_information":[{"code":"6197125","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Ot Massage","code_information":[{"code":"6297124","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Ota Massage","code_information":[{"code":"6297176","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":58,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Hep A Vac To 18 Yo","code_information":[{"code":"8090633","type":"CDM"},{"code":"250","type":"RC"},{"code":"90633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cath Foley 16fr 5cc Coude 2way 12/cs","code_information":[{"code":"2585002","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Cath Foley 16fr 5cc 2 Way Latex 12/cs","code_information":[{"code":"2586220","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586220","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Edemawear Large 1/pk","code_information":[{"code":"2587025","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2587025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Deroyal Left Universal Thumb Spica","code_information":[{"code":"2589834","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Deroyal Right Universal Thumb Spica","code_information":[{"code":"2589835","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Activated Charcoal 25 Gm","code_information":[{"code":"3000011","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689020304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Activated Charcoal 50 Gm","code_information":[{"code":"3000012","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689020108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":50,"type":"GR"}},{"description":"Creatinine","code_information":[{"code":"4000132","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Gfr Panel","code_information":[{"code":"4000209","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Triglycerides","code_information":[{"code":"4000441","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Chiropractic Manipulative Tx 1-2 Regions","code_information":[{"code":"7598940","type":"CDM"},{"code":"940","type":"RC"},{"code":"98940","type":"CPT","modifier":"AT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AT"],"minimum":56,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Act Hib 4 Dose Schedule","code_information":[{"code":"8090648","type":"CDM"},{"code":"250","type":"RC"},{"code":"90648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Atropine Drops 1% (2ml)","code_information":[{"code":"3000038","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Inshumalog Kwik Pen 100u/ml","code_information":[{"code":"3000211","type":"CDM"},{"code":"250","type":"RC"},{"code":"28799","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":55,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Morphine 50mg/ml","code_information":[{"code":"3000276","type":"CDM"},{"code":"636","type":"RC"},{"code":"40911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Rocuronium 10mg/ml","code_information":[{"code":"3000456","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219044205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alcohol (In-house)","code_information":[{"code":"4000030","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Sodium 24-hour Urine Without Creatinine","code_information":[{"code":"4000405","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Total Bilirubin","code_information":[{"code":"4000436","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Depomedrol 80 Mg","code_information":[{"code":"8071040","type":"CDM"},{"code":"636","type":"RC"},{"code":"93475","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":55,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Microalbumin-urine","code_information":[{"code":"4000308","type":"CDM"},{"code":"300","type":"RC"},{"code":"82044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Pt Paraffin Bath","code_information":[{"code":"6197018","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":55,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Pta Paraffin Bath","code_information":[{"code":"6197019","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":55,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Ot Paraffin Wax","code_information":[{"code":"6297018","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Ota Paraffin Wax","code_information":[{"code":"6297170","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Chiropractic Manual Therapy","code_information":[{"code":"7597140","type":"CDM"},{"code":"940","type":"RC"},{"code":"97140","type":"CPT","modifier":"59GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59GY"],"minimum":55,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Heparin 25,000u/250ml","code_information":[{"code":"3000200","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323052374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":25000,"type":"UN"}},{"description":"Influenza A (Rapid)","code_information":[{"code":"4000284","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":30,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Influenza B (Rapid)","code_information":[{"code":"4000286","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":30,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Streptococcus Group A Culture","code_information":[{"code":"4000312","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"4000367","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Mrsa Culture","code_information":[{"code":"4000414","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Uric Acid","code_information":[{"code":"4000450","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"4000451","type":"CDM"},{"code":"300","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Immobilizer Knee 16 Inch Universa","code_information":[{"code":"2586507","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Iv D5 Lr [1000 Ml]","code_information":[{"code":"3000220","type":"CDM"},{"code":"258","type":"RC"},{"code":"26477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":1265,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1265},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Iv Lactated Ringers 1000ml","code_information":[{"code":"3000223","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Iv Nacl 0.9% [1000ml]","code_information":[{"code":"3000227","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Iv Potassium Cl/0.9% Nacl (40meq/1000ml)","code_information":[{"code":"3000229","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Concentration-infect Agen","code_information":[{"code":"4000106","type":"CDM"},{"code":"300","type":"RC"},{"code":"87015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Glucose","code_information":[{"code":"4000213","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Gram Stain","code_information":[{"code":"4000216","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Chiropractic Manipulative Tx Extraspinal","code_information":[{"code":"7598943","type":"CDM"},{"code":"940","type":"RC"},{"code":"98943","type":"CPT","modifier":"AT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["AT"],"minimum":53,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Xxx Iv Pressure Infuser Bag","code_information":[{"code":"2585001","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2585001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Iv Pressure Infuser Bag 1000ml","code_information":[{"code":"2585022","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2585022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Xxiv Pressure Infuser Bag 5/bx","code_information":[{"code":"2587012","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2587012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Therabond 3d Antimicromial Contact Syste","code_information":[{"code":"2589777","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589777","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"4x8 Therabond 3d Contact Dressing 5/bx","code_information":[{"code":"2589779","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589779","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Alkaline Phosphatase","code_information":[{"code":"4000018","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Calcium Total","code_information":[{"code":"4000059","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Gel Ankle Brace","code_information":[{"code":"8071950","type":"CDM"},{"code":"521","type":"RC"},{"code":"L1950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":938,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":938},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Biopsy Forcep Oval Fenestrated W/ Needle","code_information":[{"code":"2586883","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Closex Laceration Closure","code_information":[{"code":"2589969","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589969","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Iv  Kcl/ 0.9% Nacl (20meq/1000ml)","code_information":[{"code":"3000219","type":"CDM"},{"code":"258","type":"RC"},{"code":"40971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Iv Nacl 0.45% [1000 Ml]","code_information":[{"code":"3000224","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Iv Nacl 0.9% 40meq Kcl1000ml","code_information":[{"code":"3000423","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Beta Lactamase","code_information":[{"code":"4000047","type":"CDM"},{"code":"300","type":"RC"},{"code":"87185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Urea Nitrogen (Bun)","code_information":[{"code":"4000053","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":59,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Bacitracin/polymixin Opth Oint","code_information":[{"code":"3000043","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478023835","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":58,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thyroglobulin Lc/ms/ms","code_information":[{"code":"4000050","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":58,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Direct Bilirubin","code_information":[{"code":"4000178","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":58,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Ttg Iga","code_information":[{"code":"4000350","type":"CDM"},{"code":"300","type":"RC"},{"code":"86364","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":58,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Total Protein","code_information":[{"code":"4000361","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":58,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Suture Prolene Blue Mono 3-0 Pc-5 12/bx","code_information":[{"code":"2580590","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580590","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Cl-depo-medrol 80mg","code_information":[{"code":"3000077","type":"CDM"},{"code":"636","type":"RC"},{"code":"93475","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":50,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Dopamine Hcl/d5 Premix (400mg/250ml)","code_information":[{"code":"3000150","type":"CDM"},{"code":"258","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Insnovolog Inj [1 Units/0.01 Ml]","code_information":[{"code":"3000214","type":"CDM"},{"code":"250","type":"RC"},{"code":"16975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pantoprazole Inj [40 Mg]/ns 10 Cc","code_information":[{"code":"3000316","type":"CDM"},{"code":"250","type":"RC"},{"code":"80941","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":50,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Occult Blood-gastric Fluid","code_information":[{"code":"4000324","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":57,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Picc Cvc Secure Dressing Kit","code_information":[{"code":"2589950","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589950","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":56,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Hep B Newborn-18yrs","code_information":[{"code":"8090744","type":"CDM"},{"code":"250","type":"RC"},{"code":"90744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":56,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Proparacaine 15ml (15ml Eye Gtts)","code_information":[{"code":"3000341","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":55,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Erythrocyte Sedimentation Rate(esr)blood","code_information":[{"code":"4000189","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":55,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Rpr (Dx)w/reflex Titer&confirmatory Test","code_information":[{"code":"4000385","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":55,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Suture Prolene Blue Mono 4-0 Ps-5","code_information":[{"code":"2580621","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580621","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Cath Foley 22fr 3 Way 30cc (Replaces 013","code_information":[{"code":"2586024","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Enluxtra 6x6 Dressing 10/pk","code_information":[{"code":"2589787","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Catheter 3 Way 24 Fr 30cc","code_information":[{"code":"2589830","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Provantage Tall Adlt Crutch Alum 53 -61","code_information":[{"code":"2589849","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589849","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Daptomycin 500mg Vial","code_information":[{"code":"3000132","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323087115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Potassium","code_information":[{"code":"4000348","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Specimen Collect Supervised","code_information":[{"code":"4000407","type":"CDM"},{"code":"270","type":"RC"},{"code":"99000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":54,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Cock-up Wrist Splint","code_information":[{"code":"8063908","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":72,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Cock Up Wrist","code_information":[{"code":"8073908","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":72,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Radial Jaw 4 Cold Biopsy","code_information":[{"code":"2588228","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2588228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":53,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Propranolol Inj [1 Mg/ml]","code_information":[{"code":"3000342","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":53,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Immobilizer Knee 20  Univ","code_information":[{"code":"2584091","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584091","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Proadvantage Adult Crutches 45 -53","code_information":[{"code":"2589855","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589855","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Lubri-sil Drain Bag Tray 16fr 10/pk","code_information":[{"code":"2589908","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589908","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Lubri-sil Drain Bag Tray 18fr 10/cs","code_information":[{"code":"2589915","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589915","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Cmv Antibody (Igg)","code_information":[{"code":"4000197","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Aerosol Inhalation Treatment","code_information":[{"code":"8094640","type":"CDM"},{"code":"521","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Albumin","code_information":[{"code":"4000014","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":51,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Shoulder Immobilizer Xxl","code_information":[{"code":"2580505","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580505","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Shoulder Immobilizer X-large","code_information":[{"code":"2587050","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2587050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"22fr Foley 2 Way Cath 5cc Ballon Ic","code_information":[{"code":"2589971","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589971","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Xxxsurestep Bardex 16fr Cath Tray","code_information":[{"code":"2589975","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589975","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Bd 18fr Coude Cath Kit","code_information":[{"code":"2589976","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589976","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Scotchcast4  Plus Red Casting Ta","code_information":[{"code":"2589977","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589977","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Cl-tubersol Ppd Inj 5 Units/0.1 Ml","code_information":[{"code":"3000112","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Orthotic/pros Use/ck Out","code_information":[{"code":"6297703","type":"CDM"},{"code":"430","type":"RC"},{"code":"97763","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":44,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Us Echo 2d Strain","code_information":[{"code":"6693356","type":"CDM"},{"code":"480","type":"RC"},{"code":"93356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":50,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Prolong Office Visit 15 Min","code_information":[{"code":"8072212","type":"CDM"},{"code":"521","type":"RC"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":49,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Stifneck Cervical Collar Reg","code_information":[{"code":"2586230","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Enluxtra 2x2 Dressing 10/pk","code_information":[{"code":"2589786","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Enluxtra 4x4 Dressing 10/bx","code_information":[{"code":"2589790","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Specimen Collection Covid-19","code_information":[{"code":"4000408","type":"CDM"},{"code":"300","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":59,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Ekg Rhythm Strip","code_information":[{"code":"5500007","type":"CDM"},{"code":"730","type":"RC"},{"code":"93041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Ankle Splint","code_information":[{"code":"8074396","type":"CDM"},{"code":"521","type":"RC"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":208,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":208},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Aerosol Inhalation Teaching","code_information":[{"code":"8094664","type":"CDM"},{"code":"521","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Phone Visit","code_information":[{"code":"8099441","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP8099441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":48,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Ted Stocking Knee Xxl Reg 2/pk 12pk/cart","code_information":[{"code":"2584062","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Cardinal Push Button Adj Alum Cruthes Ad","code_information":[{"code":"2589953","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Amoxicillin/pot Clav 250/62.5 Mg/100ml","code_information":[{"code":"3000029","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651002601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Calcium Gluc 10% Inj [10 Ml]","code_information":[{"code":"3000054","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Cyanocobalamin Inj [1000 Mcg/ml]","code_information":[{"code":"3000130","type":"CDM"},{"code":"636","type":"RC"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Doxycycline 100mg Vial","code_information":[{"code":"3000151","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fentanyl Td 25mcg/h","code_information":[{"code":"3000170","type":"CDM"},{"code":"250","type":"RC"},{"code":"59131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Eptifibatide .75mg/100ml","code_information":[{"code":"3000216","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041351","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Xarelto 10 Mg Tablet","code_information":[{"code":"3060734","type":"CDM"},{"code":"258","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xarelto 10mg Tab","code_information":[{"code":"3060738","type":"CDM"},{"code":"258","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hematocrit","code_information":[{"code":"4000234","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Knee Sleeve","code_information":[{"code":"8071810","type":"CDM"},{"code":"270","type":"RC"},{"code":"L1810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":121,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":121},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Clavicle Shoulder Brace","code_information":[{"code":"8073670","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":178,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":178},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Iv Nacl 0.9% 250ml","code_information":[{"code":"3000228","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Ql Fecal Fat Qualitative","code_information":[{"code":"4000370","type":"CDM"},{"code":"300","type":"RC"},{"code":"89125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Tb Tine","code_information":[{"code":"8086580","type":"CDM"},{"code":"250","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ted Stocking Thigh Large Reg L/f 2/pk 6p","code_information":[{"code":"2584066","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Ted Stocking Thigh Medium Reg L/f 2/pk 6","code_information":[{"code":"2584067","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Ted Stocking Thigh Small Reg L/f 2/pk 6p","code_information":[{"code":"2584068","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584068","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Edemawear Medium 34  1/pk","code_information":[{"code":"2586843","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Complete Care Cath Tray Add A Cath","code_information":[{"code":"2589949","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589949","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Isovue 370  75ml","code_information":[{"code":"2589983","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Occult Blood-stool Gi Bleed #3","code_information":[{"code":"4000328","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Occult Blood-stool Gi Bleed #1","code_information":[{"code":"4000329","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Occult Blood-stool Gi Bleed #2","code_information":[{"code":"4000330","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Cl Administer Injection","code_information":[{"code":"8096372","type":"CDM"},{"code":"521","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Cock Up Splint Sm Left 8","code_information":[{"code":"2580500","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch R-lrg","code_information":[{"code":"2580581","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch L-med","code_information":[{"code":"2580582","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch L-lrg","code_information":[{"code":"2580583","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch R-xlrg","code_information":[{"code":"2580584","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cockup Wrist Splint 8 Inch L-xlrg","code_information":[{"code":"2580585","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Envelope Arm Sling W/pad Xl","code_information":[{"code":"2580589","type":"CDM"},{"code":"274","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Shoulder Immobilizer Medium","code_information":[{"code":"2580592","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580592","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch R-med","code_information":[{"code":"2580599","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock Up Splint Xs Left 8","code_information":[{"code":"2584098","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock Up Splint Xs Right 8","code_information":[{"code":"2584099","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock-up Wrist Splint 8 Inch R-sm","code_information":[{"code":"2586732","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":72,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Cock Up Spint Left Small 8","code_information":[{"code":"2589766","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589766","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Wrist Splint Lt Small Black","code_information":[{"code":"2589929","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589929","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Benzoin Compound Tincture","code_information":[{"code":"3000046","type":"CDM"},{"code":"250","type":"RC"},{"code":"57491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylprednisolone Inj [1 Gm]","code_information":[{"code":"3000261","type":"CDM"},{"code":"636","type":"RC"},{"code":"90698","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Norepinephrine Inj [4 Mg/4 Ml]","code_information":[{"code":"3000302","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Envelope Arm Sling W/pad Med","code_information":[{"code":"2580587","type":"CDM"},{"code":"274","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Envelope Arm Sling W/pad Large","code_information":[{"code":"2580588","type":"CDM"},{"code":"274","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Easycap Co2 Detectors","code_information":[{"code":"2584038","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Puracol Plus Ag 2x2 Dressing Collagen","code_information":[{"code":"2585004","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP2585004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Foley Catheter 30cc 2way 24fr","code_information":[{"code":"2586207","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586207","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Pedicap Co2 Detectors","code_information":[{"code":"2586806","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586806","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Primary Plumset W/out Cassette 50/cs","code_information":[{"code":"2587000","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP2587000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Heparin 5000u/ml","code_information":[{"code":"3000201","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Tamiflu Susp (Oseltavivir) 6mg/ml","code_information":[{"code":"3000367","type":"CDM"},{"code":"250","type":"RC"},{"code":"40822","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Screening Pap Test","code_information":[{"code":"8070091","type":"CDM"},{"code":"521","type":"RC"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Screening Pelvic Breast Exam","code_information":[{"code":"8070101","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Nursing Visit","code_information":[{"code":"8099211","type":"CDM"},{"code":"521","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":59,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"18fr Salem Sump W/gientri Port","code_information":[{"code":"2584025","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Resuscitator W/ Port Pediatric 6/cs","code_information":[{"code":"2584069","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Ceftriaxone Inj [2 Gm] Vial","code_information":[{"code":"3000062","type":"CDM"},{"code":"636","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Iv Nacl 0.9% [100ml]","code_information":[{"code":"3000226","type":"CDM"},{"code":"258","type":"RC"},{"code":"40979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Rocephin 250mg","code_information":[{"code":"3000347","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Double Wrap Anklet","code_information":[{"code":"8071906","type":"CDM"},{"code":"521","type":"RC"},{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":145,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":145},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Shoulder Immobilizer Small","code_information":[{"code":"2580591","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580591","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Suture Coated Vicryl Ud 5-0","code_information":[{"code":"2580607","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580607","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Suture Coated Vicryl Ud 3-0 Ps-1","code_information":[{"code":"2580608","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580608","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Shoulder Immobilizer Large","code_information":[{"code":"2586443","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586443","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Edemawear Small 2/pk 22","code_information":[{"code":"2587023","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2587023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Promogran Prisma Ag 4 34sq Dressing","code_information":[{"code":"2589769","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589769","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Aquacel Ag Extra 4x5 10/bx","code_information":[{"code":"2589780","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589780","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Xxted Knee Small Reg L/f","code_information":[{"code":"2589793","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589793","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Picc/cvc Securement 3m Device + Secureme","code_information":[{"code":"2589869","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589869","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Clavicle Strap W/ Buckle Adult","code_information":[{"code":"2580112","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Clavicle Strap W/ Buckle Med/lg","code_information":[{"code":"2580113","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"18fr Coude Cath 5cc Teflon Coated","code_information":[{"code":"2587051","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Ctp 200 Fls Tri Pak Syringe","code_information":[{"code":"2587052","type":"CDM"},{"code":"255","type":"RC"},{"code":"CP2587052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Post Op Shoe Male Xl","code_information":[{"code":"2588270","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Urinary Catheter 20fr 5cc Coude","code_information":[{"code":"2589816","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589816","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Allevyn Life Dressing 6 06'' X 6 06'' Qu","code_information":[{"code":"2589917","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589917","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Aquacel Ag Foam Dressing 10/bx","code_information":[{"code":"2589930","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589930","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Xgeva 120 Mg Inj","code_information":[{"code":"3000414","type":"CDM"},{"code":"636","type":"RC"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Hemoglobin","code_information":[{"code":"4000235","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Urinalysis test","code_information":[{"code":"4000452","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Observ Room Per Hour","code_information":[{"code":"240025","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Cath Urinary 16fr 5cc Coude Teflon 12/cs","code_information":[{"code":"2584056","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Male External Texas Catheter","code_information":[{"code":"2585019","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Iv D5w 250ml","code_information":[{"code":"3000222","type":"CDM"},{"code":"258","type":"RC"},{"code":"26475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Iv Dextrose 5% .45 Nacl 1000/ml Hosp","code_information":[{"code":"3000424","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Occult Blood-stool #1","code_information":[{"code":"4000325","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Occult Blood-stool #2","code_information":[{"code":"4000326","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Occult Blood-stool #3","code_information":[{"code":"4000327","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Mcr Admin Flu Shot","code_information":[{"code":"8070008","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Mcr Admin Pneumo Shot","code_information":[{"code":"8070009","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Influenza B","code_information":[{"code":"8077804","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":30,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Fibromyalgia Form","code_information":[{"code":"8079999","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP8079999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Influenza A","code_information":[{"code":"8087804","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":30,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Pmc Rsv Nasal Swab","code_information":[{"code":"8087807","type":"CDM"},{"code":"300","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Administer Vaccine","code_information":[{"code":"8090471","type":"CDM"},{"code":"521","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Pmc Influenza A/b Nasal Swab","code_information":[{"code":"8067804","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Pmc Rapid Strep A","code_information":[{"code":"8087880","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Hib Vaccine","code_information":[{"code":"8090647","type":"CDM"},{"code":"250","type":"RC"},{"code":"90647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":41,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Post Op Shoe Female Child","code_information":[{"code":"2580507","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Urgotul  Ag 4x5 Contact Layer Dressing","code_information":[{"code":"2585035","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Post Op Shoe Male Small","code_information":[{"code":"2589709","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Post Op Shoe Male Med","code_information":[{"code":"2589710","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589710","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Post Op Shoe Male Lg","code_information":[{"code":"2589711","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589711","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Post Op Female Lg","code_information":[{"code":"2589712","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589712","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Female Post Op Shoe Sm W/ Velcro","code_information":[{"code":"2589760","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589760","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Female Pot Op Shoe Med W/ Velcro","code_information":[{"code":"2589761","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589761","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Dressing Tegaderm Tegasorb Sacral Hydroc","code_information":[{"code":"2589831","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589831","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Cefazolin [1 Gm] Vial","code_information":[{"code":"3000060","type":"CDM"},{"code":"636","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dobutamine Inj [250 Mg/20 Ml]","code_information":[{"code":"3000148","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436020380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Meropenem 1 Gm","code_information":[{"code":"3000259","type":"CDM"},{"code":"636","type":"RC"},{"code":"25021015630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ofirmev (Tylenol Iv) 1000mg/100ml","code_information":[{"code":"3000306","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021070587","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Vancomycin Inj [1 Gm]","code_information":[{"code":"3000384","type":"CDM"},{"code":"636","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Diprivan (Propofol) 10mg/ml","code_information":[{"code":"3000425","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026957","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cefazolin 1gm/10ml Ns","code_information":[{"code":"3060703","type":"CDM"},{"code":"258","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Pt Hot Pack/cold Pack","code_information":[{"code":"6197010","type":"CDM"},{"code":"420","type":"RC"},{"code":"97010","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Pta Hot Pack/cold Pack","code_information":[{"code":"6197011","type":"CDM"},{"code":"420","type":"RC"},{"code":"97010","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Ot Hot Pack","code_information":[{"code":"6297010","type":"CDM"},{"code":"430","type":"RC"},{"code":"97010","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Ota Hot Pack","code_information":[{"code":"6297169","type":"CDM"},{"code":"430","type":"RC"},{"code":"97010","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":33,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Additional Vaccine Administration","code_information":[{"code":"8090472","type":"CDM"},{"code":"521","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Allergy Inject-multiple","code_information":[{"code":"8095117","type":"CDM"},{"code":"250","type":"RC"},{"code":"95117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Range Of Motion","code_information":[{"code":"8095851","type":"CDM"},{"code":"521","type":"RC"},{"code":"95851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Vision Exam","code_information":[{"code":"8099172","type":"CDM"},{"code":"521","type":"RC"},{"code":"99172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Vision Exam","code_information":[{"code":"8099173","type":"CDM"},{"code":"521","type":"RC"},{"code":"99173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Suture Ethilon Black Mono 4-0 P-3 12/bx","code_information":[{"code":"2580602","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580602","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Sm Rt Black Cock Up Wrist Splint","code_information":[{"code":"2585052","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Black Lt Medium Wrist Splint Cock-up","code_information":[{"code":"2589090","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":72,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Black Wrist Splint Right Medium Cock Up","code_information":[{"code":"2589886","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":72,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Xs Rt Black Cock Up Wrist Splint","code_information":[{"code":"2589888","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589888","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Right Large Wrist 8  Cock Up Black","code_information":[{"code":"2589890","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589890","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Left Large 8  Cock Up Black","code_information":[{"code":"2589891","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589891","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Xl Left 8  Cock Up Black","code_information":[{"code":"2589892","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589892","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Lidocaine Inj Syr [10 Mg/5 Ml]","code_information":[{"code":"3000245","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sod Bicarb Inj  [50 Meq/50 Ml]","code_information":[{"code":"3000357","type":"CDM"},{"code":"250","type":"RC"},{"code":"81665020025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Fecal Fat","code_information":[{"code":"4000468","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Rt Xl Black Wrist Splint Cock Up","code_information":[{"code":"2589901","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589901","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Lt X-small Black Wrist Splint Cock-up","code_information":[{"code":"2589967","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589967","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cl-b12 (Cyanocobalamin) 1000mcg","code_information":[{"code":"3000073","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Naloxone Inj [0.4 Mg/ml]","code_information":[{"code":"3000282","type":"CDM"},{"code":"636","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Culture Bacterial Id","code_information":[{"code":"4000149","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":16,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Microscopic Examination-urine","code_information":[{"code":"4000309","type":"CDM"},{"code":"300","type":"RC"},{"code":"81015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cast Sandal","code_information":[{"code":"8073265","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"B-12 Injection","code_information":[{"code":"8073420","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Influenza Intraderm 18-64","code_information":[{"code":"8090654","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP8090654","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Report Or Recertification","code_information":[{"code":"8319080","type":"CDM"},{"code":"521","type":"RC"},{"code":"99080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cervical Collar Pedi Univ","code_information":[{"code":"2580574","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580574","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Inf Set 19g X 1 5 Huber Power Loc","code_information":[{"code":"2589791","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589791","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Purewick Female External Catheter","code_information":[{"code":"2589959","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Acetylcysteine Soln 20% [200 Mg/ml-10 Ml","code_information":[{"code":"3000010","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pipereracillin-tazobactam 2.25gm Vial","code_information":[{"code":"3000323","type":"CDM"},{"code":"250","type":"RC"},{"code":"78193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Cervical Collar","code_information":[{"code":"8060120","type":"CDM"},{"code":"270","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":43,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Valproate Sodium 500mg/5ml (5ml Vial)","code_information":[{"code":"3000383","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":35,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Promogran 4 34in Hexagon Matrix Dressing","code_information":[{"code":"2589767","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589767","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Tielle 3 1/8 X5 7/8  Dressing","code_information":[{"code":"2589770","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589770","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Cotton Stockinette 2  X 25yds","code_information":[{"code":"2589794","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589794","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Clindamycin 300mg/2ml","code_information":[{"code":"3000120","type":"CDM"},{"code":"250","type":"RC"},{"code":"90870","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Epinephrine Inj [1 Mg/ml]","code_information":[{"code":"3000161","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flumazenil Inj 1mg/10ml","code_information":[{"code":"3000178","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bicillin La 100000 Units","code_information":[{"code":"8070561","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Depomedrol 40 Mg","code_information":[{"code":"8071030","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":34,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Meplilex Border Sacrum 5layer Dressing","code_information":[{"code":"2585041","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Meplilex Border Sacrum Dressing","code_information":[{"code":"2587027","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Hydrofera Blue Foam 4x5 10/bx","code_information":[{"code":"2589952","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589952","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Adenosine Inj [6 Mg/2 Ml]","code_information":[{"code":"3000013","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Amiodarone Inj [150 Mg/3 Ml]","code_information":[{"code":"3000022","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cl-bicillin L-a 600000u","code_information":[{"code":"3000076","type":"CDM"},{"code":"636","type":"RC"},{"code":"54569587600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":600000,"type":"UN"}},{"description":"Fosphenytoin Sodium 50 Mg Pe/2ml","code_information":[{"code":"3000182","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Promethazine Inj [25 Mg/ml]","code_information":[{"code":"3000338","type":"CDM"},{"code":"636","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tranexamic Acid Injection1gm","code_information":[{"code":"3000377","type":"CDM"},{"code":"250","type":"RC"},{"code":"13111","type":"CPT","modifier":"420"}],"standard_charges":[{"setting":"outpatient","modifier_code":["420"],"minimum":29,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Venipuncture","code_information":[{"code":"4000459","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":33,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Post Op Shoe Male Large Replaces 2001-04","code_information":[{"code":"2580506","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580506","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"C-collar X-small 2  X 19 5","code_information":[{"code":"2586236","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"16fr Foley Cath 2 Way Ic","code_information":[{"code":"2589805","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589805","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"35w Disp Skin Stapler","code_information":[{"code":"2589840","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589840","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Ampicillin 1 Gm Inj","code_information":[{"code":"3000030","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Enalapril Inj [1.25 Mg/ml]","code_information":[{"code":"3000158","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Morphine 100mg/5ml (30ml Bottle)","code_information":[{"code":"3000274","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383096530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine 10mg/ml","code_information":[{"code":"3000275","type":"CDM"},{"code":"636","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cefepime 2gm/20ml Ns","code_information":[{"code":"3000446","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505614504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Capillary Blood Collectio","code_information":[{"code":"4000065","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Urinalysis test","code_information":[{"code":"4000177","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Norflex 60 Mg","code_information":[{"code":"8072360","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Terramycin 2 Cc","code_information":[{"code":"8072460","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Support Stocking","code_information":[{"code":"8078239","type":"CDM"},{"code":"521","type":"RC"},{"code":"A6538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Post Op Shoe","code_information":[{"code":"8079270","type":"CDM"},{"code":"521","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Dt Vaccine >7 Yrs","code_information":[{"code":"8090718","type":"CDM"},{"code":"250","type":"RC"},{"code":"90718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":32,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Abd Binder Sm/med 9  30 -45","code_information":[{"code":"2580037","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":31,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Ephedrine Sulf Inj 50mg/ml","code_information":[{"code":"3000160","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":31,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Zithromax 500mg Vial","code_information":[{"code":"3000421","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":31,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Norepinephrine/ns Ivpb : 4mg/250ml","code_information":[{"code":"3060722","type":"CDM"},{"code":"258","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":31,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Crutches","code_information":[{"code":"8070112","type":"CDM"},{"code":"270","type":"RC"},{"code":"E0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":31,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Clavicle Brace Child (Replaces 3003-02 3","code_information":[{"code":"2584094","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584094","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Clavicle Brace Med (Replaces 3003-03)","code_information":[{"code":"2584095","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584095","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Icu Medical Man Resuscitator Neonatal","code_information":[{"code":"2585017","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Airlife Resuscitator Infant","code_information":[{"code":"2585018","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Clavicle Brace Small","code_information":[{"code":"2585029","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Clavicle Brace Child (Replaces 3003-02 3","code_information":[{"code":"2585032","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Iv Start Kit Standard 100/cs","code_information":[{"code":"2587900","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2587900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Adult Resuscitator Ambu","code_information":[{"code":"2589813","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589813","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Bard Ic 18fr 5cc 2 Way Catheter","code_information":[{"code":"2589860","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589860","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Diltiazem Hcl 25mg/5ml","code_information":[{"code":"3000058","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019051001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Digoxin Inj","code_information":[{"code":"3000141","type":"CDM"},{"code":"250","type":"RC"},{"code":"64114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin Cream [100,000 Units/gm]","code_information":[{"code":"3000304","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Sod Bicarb Infant Inj Syr [5 Meq/10 Ml]","code_information":[{"code":"3000356","type":"CDM"},{"code":"250","type":"RC"},{"code":"40955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Blood Glucose Fingerstick (Mar)","code_information":[{"code":"3060749","type":"CDM"},{"code":"270","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orthopedic Shoe Junior","code_information":[{"code":"8073207","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":57,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Canvas Upper Wood Shoe","code_information":[{"code":"8073260","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":30,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Diphenhydramine Inj [50 Mg/ml]","code_information":[{"code":"3000146","type":"CDM"},{"code":"636","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lorazepam Inj [2 Mg/ml]","code_information":[{"code":"3000249","type":"CDM"},{"code":"636","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ceftraixone 2gm/20ml Ns","code_information":[{"code":"3060704","type":"CDM"},{"code":"258","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Demerol 75mg Inj","code_information":[{"code":"8062175","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Phone Visit Medicare","code_information":[{"code":"8070071","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0511","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":26,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Demerol Hci 100 Mg","code_information":[{"code":"8072175","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Phenergan 25 Mg Inj","code_information":[{"code":"8072550","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Subcutaneous Injection Vials","code_information":[{"code":"8095165","type":"CDM"},{"code":"521","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":29,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Walking Cast Heel 12/bx","code_information":[{"code":"2586300","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Acetylcysteine 10% Solution","code_information":[{"code":"3000009","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Amidate Inj 2mg/ml","code_information":[{"code":"3000021","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Atropine Inj [0.1 Mg/ml]","code_information":[{"code":"3000039","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ciprofloxacin/ D5w 200mg/100ml Premix","code_information":[{"code":"3000068","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000000824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Gentamicin Inj [40 Mg/ml] 2ml Vl","code_information":[{"code":"3000190","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Iv D50w 50% Inj Syr [50 Ml]","code_information":[{"code":"3000221","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Oxytocin Inj [10 Units/ml]","code_information":[{"code":"3000315","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"UN"}},{"description":"Thiamine Inj [100 Mg/ml]","code_information":[{"code":"3000373","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485050725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dexamethasone 4mg Iv","code_information":[{"code":"3000428","type":"CDM"},{"code":"636","type":"RC"},{"code":"CP3000428","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Calcium Glucanate/ns Ivpb : 100mg/100ml","code_information":[{"code":"3060706","type":"CDM"},{"code":"258","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Piperacill-taz/ns Ivpb : 2.25gm/100ml","code_information":[{"code":"3060724","type":"CDM"},{"code":"258","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Urine Volume Mst.","code_information":[{"code":"4000454","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Cpr Valve Mask Orange W/case","code_information":[{"code":"2584082","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584082","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Tielle Lte 4 1/4  X 4 1/4  Dressing","code_information":[{"code":"2589771","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589771","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Allevyn Life Sacral 6 3/4 X6 7/8  10/bx","code_information":[{"code":"2589904","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589904","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Metronidazole/nacl 500 Mg/100 Ml Premix","code_information":[{"code":"3000268","type":"CDM"},{"code":"250","type":"RC"},{"code":"40901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Neomycin/polymixin/hydrocort Otic Susp","code_information":[{"code":"3000285","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketamine Md 50mg/ml","code_information":[{"code":"3000460","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021068310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Urea Nitrogen-urine","code_information":[{"code":"4000372","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Progesterone 100 Mg","code_information":[{"code":"8072675","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Coag/inr Finger Stick","code_information":[{"code":"100020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP100020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Ted Stocking Knee Xl Reg 2/pk 12pk/cartn","code_information":[{"code":"2584063","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Ted Stocking Knee Large Reg 2/pk 12pk/ca","code_information":[{"code":"2584064","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Deluxe Clavicle Strap Xl","code_information":[{"code":"2585036","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Wet Skin Prep Tray Medline","code_information":[{"code":"2587016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2587016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Unna Boot 3  X 10yds Elastic 12/bx","code_information":[{"code":"2587037","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Deluxe Clavicle Strap Adult","code_information":[{"code":"2589846","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589846","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Scotchcast Plus 3  White 10/bx","code_information":[{"code":"2589861","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589861","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Neomycin/polymixin/dexametha Opth Oint","code_information":[{"code":"3000284","type":"CDM"},{"code":"250","type":"RC"},{"code":"48102000335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Antibody Screen Auto","code_information":[{"code":"4000032","type":"CDM"},{"code":"300","type":"RC"},{"code":"86940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Specimen Collection Fee","code_information":[{"code":"4000409","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4000409","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Specimen Handling Charge","code_information":[{"code":"4000410","type":"CDM"},{"code":"270","type":"RC"},{"code":"99000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Primary Plumset Clave Y-site 103 Inch 48","code_information":[{"code":"2500045","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2500045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Coach 2 Spirometer 12/cs","code_information":[{"code":"2580060","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Knee Support Xl W/open Patella 21  X 24","code_information":[{"code":"2580518","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580518","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Knee Support Med W/ Open Patella 15 X18","code_information":[{"code":"2580519","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580519","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Knee Support Small W/ Open Patella 12 X1","code_information":[{"code":"2580520","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ankle Support Aso Small","code_information":[{"code":"2580521","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580521","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Emt Select Cervical Collar Ad","code_information":[{"code":"2580573","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Knee Support W/open Patella Lg","code_information":[{"code":"2580586","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580586","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Suture Coated Vicryl Ud 3-0 Fs-1","code_information":[{"code":"2580606","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Stocking Knee Med Reg Lgth","code_information":[{"code":"2584000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Salem Sump Tube 8fr 24 Inch","code_information":[{"code":"2584021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Tube, Suction 1/4 X 10' St","code_information":[{"code":"2585003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Ted Stocking Knee Sm Reg Lgth","code_information":[{"code":"2586840","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586840","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Rt Angle (90 Degree)neddles Safety 12/bx","code_information":[{"code":"2589819","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589819","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Cat Tourniquet 4/pk","code_information":[{"code":"2589910","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589910","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Gastrographin 1 Bottle","code_information":[{"code":"2589978","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Lidocaine Hcl Oral Soln 2%","code_information":[{"code":"3000244","type":"CDM"},{"code":"250","type":"RC"},{"code":"54350","type":"CPT","modifier":"49"}],"standard_charges":[{"setting":"outpatient","modifier_code":["49"],"minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Famotidine 40mg/4ml","code_information":[{"code":"3000318","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457044843","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab [5 Mg]","code_information":[{"code":"3000348","type":"CDM"},{"code":"250","type":"RC"},{"code":"31007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Terbutaline Inj 1mg/ml","code_information":[{"code":"3000369","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vecuronium Bromide Inj [10 Mg/ml]","code_information":[{"code":"3000385","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gastrographin 1 Bottle","code_information":[{"code":"5210067","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP5210067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Allergy Inject-single","code_information":[{"code":"8095115","type":"CDM"},{"code":"250","type":"RC"},{"code":"95115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ext Set W/0.2 Micron Filter","code_information":[{"code":"800024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP800024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ext Set W/ 0.2 Micron Filter","code_information":[{"code":"2500040","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2500040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Colles Hand Splint Rt Sm(replaces 9106-0","code_information":[{"code":"2580516","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580516","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ext Set Microbore 120/cs","code_information":[{"code":"2586470","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2586470","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Alumifoam Colles Lt Sm","code_information":[{"code":"2589765","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589765","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Vyaire  Sterile Water For Inhalation","code_information":[{"code":"2589958","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Acetaminophen Supp [325 Mg]","code_information":[{"code":"3000002","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Acetaminophen/codeine Liq [12 Mg/5 Ml]","code_information":[{"code":"3000008","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383007916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Amoxicillin Susp [250 Mg/5 Ml-100 Ml]","code_information":[{"code":"3000027","type":"CDM"},{"code":"250","type":"RC"},{"code":"67253014846","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Artificial Tears","code_information":[{"code":"3000031","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896018405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclobenzaprine Tab [10 Mg]","code_information":[{"code":"3000131","type":"CDM"},{"code":"250","type":"RC"},{"code":"60330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gentamicin 0.3% Opth Oint","code_information":[{"code":"3000189","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ibuprofen Liq [100 Mg/5 Ml]","code_information":[{"code":"3000208","type":"CDM"},{"code":"250","type":"RC"},{"code":"37205066026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levofloxacin Tab250 Mg","code_information":[{"code":"3000241","type":"CDM"},{"code":"250","type":"RC"},{"code":"90463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Lidocaine 1% Inj [1 Ml]","code_information":[{"code":"3000243","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Mupirocin 2% Oint","code_information":[{"code":"3000281","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ofloxacin Opth Soln 0.3%","code_information":[{"code":"3000307","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Oxycodone/ Acet Tab [5-325 Mg]","code_information":[{"code":"3000314","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084035511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Tobramycin 0.3% Opth Sol","code_information":[{"code":"3000374","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Triamcinolone 0.5% Cream [80 Gm]","code_information":[{"code":"3000379","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":80,"type":"GR"}},{"description":"Xylocaine 1% Inj [1 Mg/ml]","code_information":[{"code":"3000415","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Xylocaine W/epi 1%/1:100000 Inj [1 Ml]","code_information":[{"code":"3000417","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Zolpidem Tab [5 Mg]","code_information":[{"code":"3000422","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079072401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydroxyzine 25mg Po","code_information":[{"code":"3000437","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155050101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroxyzine Hcl Oral Tablet 25mg","code_information":[{"code":"3061051","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155050101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Direct Antiglobulin Test (Dat)","code_information":[{"code":"4000375","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ativan Inj","code_information":[{"code":"8072060","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cast Shoe Open Toe","code_information":[{"code":"8073255","type":"CDM"},{"code":"521","type":"RC"},{"code":"L3255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Oval 8 Finger Splint","code_information":[{"code":"8073927","type":"CDM"},{"code":"270","type":"RC"},{"code":"L3927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":41,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Nf-belsomra Oral Tablet 10mg","code_information":[{"code":"3060761","type":"CDM"},{"code":"250","type":"RC"},{"code":"60033","type":"CPT","modifier":"13"}],"standard_charges":[{"setting":"outpatient","modifier_code":["13"],"minimum":21,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Suture Silk Black Br 4-0 Fs-1","code_information":[{"code":"2580600","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580600","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Cath Foley 30fr 5cc 2 Way Latex 12/cs","code_information":[{"code":"2584059","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Clavicle Strap (Replaces V9908-01)","code_information":[{"code":"2584096","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584096","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Wet Skin-prep Tray Kendall","code_information":[{"code":"2586809","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Oval 8 Combo Pack Sizes 3-7- 5/pk","code_information":[{"code":"2589842","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589842","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Bupivacaine 0.25% Inj [1 Ml]","code_information":[{"code":"3000051","type":"CDM"},{"code":"250","type":"RC"},{"code":"40915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Bupivacaine Hcl 0.5%","code_information":[{"code":"3000052","type":"CDM"},{"code":"250","type":"RC"},{"code":"40915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cl- Acthib (Haemophilus B Conj)","code_information":[{"code":"3000070","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281054505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cl -Ativan Inj 2 Mg","code_information":[{"code":"3000072","type":"CDM"},{"code":"250","type":"RC"},{"code":"40967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fentanyl Citrate 50mcg/2ml","code_information":[{"code":"3000169","type":"CDM"},{"code":"250","type":"RC"},{"code":"40990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Morphine Sulfate 2 Mg/ml","code_information":[{"code":"3000278","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Phytonadione 10mg/ml","code_information":[{"code":"3000432","type":"CDM"},{"code":"636","type":"RC"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Furosemide Sf 10mg/ml","code_information":[{"code":"3000433","type":"CDM"},{"code":"636","type":"RC"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin/nacl 600 Mg/50 Ml Premix","code_information":[{"code":"3000436","type":"CDM"},{"code":"250","type":"RC"},{"code":"33836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Nacl Vial 20ml","code_information":[{"code":"3000452","type":"CDM"},{"code":"258","type":"RC"},{"code":"40919","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Trelegy Ellip Inhalher","code_information":[{"code":"3000459","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nf-refresh Ophth Solution","code_information":[{"code":"3061089","type":"CDM"},{"code":"250","type":"RC"},{"code":"23050","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Potassium-urine","code_information":[{"code":"4000369","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Rapid Drg Test Cup-for Mc","code_information":[{"code":"8070434","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Rapid Drug Test Cup","code_information":[{"code":"8080104","type":"CDM"},{"code":"300","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ekg Interpretation And Report Only","code_information":[{"code":"8093010","type":"CDM"},{"code":"730","type":"RC"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Ear Bulb Syringe 2oz 24/cs","code_information":[{"code":"2580619","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580619","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Salem Sump Tube/reflux 12fr","code_information":[{"code":"2584020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Pad Wheelchair 3 1/2 Inch 2 Inch Deep","code_information":[{"code":"2584031","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Mepilex Post Op Border 4x10","code_information":[{"code":"2585042","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Pad Wheelchair 4  Pink Egg Crate","code_information":[{"code":"2585118","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Plaster Splint Roll 4 Inch X 20'","code_information":[{"code":"2586656","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586656","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Mepilex Ag Border 4x10","code_information":[{"code":"2589704","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589704","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Valve Anti-reflux Sterile","code_information":[{"code":"2589706","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589706","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Kleen Spec Medium 24/bx","code_information":[{"code":"2589735","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Foley Cath 6 Fr","code_information":[{"code":"2589742","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589742","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Wound Wash Saline 210cc","code_information":[{"code":"2589757","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589757","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Heel Protector Sheepskin 2/pr","code_information":[{"code":"2589806","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589806","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Male Medium Post Op Shoe","code_information":[{"code":"2589940","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Xl Open Patella Knee Support Without Ova","code_information":[{"code":"2589951","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Metoclopramide Inj( (5mg/ml)","code_information":[{"code":"3000263","type":"CDM"},{"code":"250","type":"RC"},{"code":"40934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cv Smear & Hormonal Ev","code_information":[{"code":"4000168","type":"CDM"},{"code":"300","type":"RC"},{"code":"88155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":27,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Mepilex 18x18 Dressing","code_information":[{"code":"8076213","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Suture Prolene P-3 6-0 12/bx","code_information":[{"code":"2580558","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580558","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Suture Ethilon Black Mono 3-0 Fs-1","code_information":[{"code":"2580601","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580601","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Rt Angle Infusion Set 20g 1  W/ Y Site 1","code_information":[{"code":"2589804","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589804","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Central Line Dressing Kit W/ Tegaderm","code_information":[{"code":"2589822","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589822","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Cl-toradol (Ketorolac)","code_information":[{"code":"3000111","type":"CDM"},{"code":"636","type":"RC"},{"code":"65145014725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydralazine Inj [20 Mg/ml]","code_information":[{"code":"3000203","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323061455","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ketorolac 30mg/ml (1ml Vial)","code_information":[{"code":"3000232","type":"CDM"},{"code":"250","type":"RC"},{"code":"65145014725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dilaudid .1mg","code_information":[{"code":"8071170","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Valium 2 Mg","code_information":[{"code":"8073360","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Vistaril 25 Mg","code_information":[{"code":"8073410","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Abduction Finger Splint","code_information":[{"code":"8073805","type":"CDM"},{"code":"521","type":"RC"},{"code":"Q4049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Sling","code_information":[{"code":"8074565","type":"CDM"},{"code":"270","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Suture Prolene 5-0 Ps-3 Blue 12/bx","code_information":[{"code":"2589732","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589732","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Alumi Foam Rt Sm Colles","code_information":[{"code":"2589759","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589759","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Allevyn 5x5 Dressing","code_information":[{"code":"2589776","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589776","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"D/c Multi-shot Skin Stapler","code_information":[{"code":"2589784","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589784","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Medline Pill Splitter Blue","code_information":[{"code":"2589900","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP2589900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pill Crusher","code_information":[{"code":"2589902","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP2589902","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cefdinir 250mg/5ml","code_information":[{"code":"3000061","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythromycin Opth Oint","code_information":[{"code":"3000163","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Furosemide Inj  20mg","code_information":[{"code":"3000184","type":"CDM"},{"code":"636","type":"RC"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Haloperidol Inj [5 Mg/ml]","code_information":[{"code":"3000199","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Magnesium Sulf 50%  Inj 0.5g/ml 20ml Vl","code_information":[{"code":"3000255","type":"CDM"},{"code":"636","type":"RC"},{"code":"40921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Phytonadione Inj [1 Mg/0.5 Ml]","code_information":[{"code":"3000321","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Prednisolone 15mg/5ml (240ml Bottle)","code_information":[{"code":"3000330","type":"CDM"},{"code":"250","type":"RC"},{"code":"12107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Protamine Inj [250 Mg]","code_information":[{"code":"3000343","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022935","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Tubersol Ppd Inj [5 Tu/0.1 Ml]","code_information":[{"code":"3000380","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Glutathione Solution","code_information":[{"code":"3000442","type":"CDM"},{"code":"636","type":"RC"},{"code":"72627240301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Taurine Solution","code_information":[{"code":"3000443","type":"CDM"},{"code":"636","type":"RC"},{"code":"72627240301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiracetam/ns Ivpb : 100mg/100ml","code_information":[{"code":"3060718","type":"CDM"},{"code":"258","type":"RC"},{"code":"99999999999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levetiractam 100mg/ml","code_information":[{"code":"3060740","type":"CDM"},{"code":"258","type":"RC"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"High Flow Oxygen","code_information":[{"code":"6700001","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Fentanyl Citrate","code_information":[{"code":"8073010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pmc Urine Pregnancy Test","code_information":[{"code":"8081025","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Aloe 2 In 1 Protect Ointment","code_information":[{"code":"2580569","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580569","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint R-medium","code_information":[{"code":"2580594","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580594","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint R-large","code_information":[{"code":"2580595","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580595","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint L-medium","code_information":[{"code":"2580596","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580596","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint L-large","code_information":[{"code":"2580597","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580597","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"C-collar Med Density Large 4","code_information":[{"code":"2584093","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584093","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint R-lg","code_information":[{"code":"2585030","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint L-lg","code_information":[{"code":"2585031","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Colles Wrist Splint Lt Large","code_information":[{"code":"2585034","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2585034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Suture Prolene Tp-1 2-0 12/bx","code_information":[{"code":"2587034","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Male Post Op Shoe Small 6-8","code_information":[{"code":"2589878","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Male Post Op Shoe Lg 10 5-12","code_information":[{"code":"2589879","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Female Post Op Shoe Large 8 5-10","code_information":[{"code":"2589880","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Midazolam 2mg/2ml (2ml Vial)","code_information":[{"code":"3000269","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781058868","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Midazolam Inj 5 Mg/ml","code_information":[{"code":"3000270","type":"CDM"},{"code":"636","type":"RC"},{"code":"40925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oseltamivir Cap [75 Mg]","code_information":[{"code":"3000312","type":"CDM"},{"code":"250","type":"RC"},{"code":"40800","type":"CPT","modifier":"85"}],"standard_charges":[{"setting":"outpatient","modifier_code":["85"],"minimum":17,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mucin Synovial Fld","code_information":[{"code":"4000313","type":"CDM"},{"code":"300","type":"RC"},{"code":"83872","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Depression Screen Annual","code_information":[{"code":"8070444","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Nf-vascepa Oral Liquid Filled Cap 1gm","code_information":[{"code":"3060760","type":"CDM"},{"code":"250","type":"RC"},{"code":"52937010108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tegaderm Hydrocolliod 4  X 4 5  50/bx","code_information":[{"code":"2580142","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 26fr","code_information":[{"code":"2580513","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 32fr","code_information":[{"code":"2580514","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580514","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 34fr","code_information":[{"code":"2580515","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 28fr","code_information":[{"code":"2584016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 30fr","code_information":[{"code":"2584017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 32fr","code_information":[{"code":"2584018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 34fr","code_information":[{"code":"2584019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 30fr","code_information":[{"code":"2585011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Incentive Spirometer Voldyne 4000ml","code_information":[{"code":"2585053","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Envelope Arm Sling W/pad Small","code_information":[{"code":"2586085","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586085","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Airway Nasopharyngeal 26fr","code_information":[{"code":"2589703","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589703","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Incentive Spirometer","code_information":[{"code":"2589826","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589826","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Gripper Plus Safety Needle Non Y-site 20","code_information":[{"code":"2589911","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589911","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ez-stabilizer(box Of 5)","code_information":[{"code":"2589923","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589923","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Azithromycin Susp [200 Mg/5 Ml]","code_information":[{"code":"3000041","type":"CDM"},{"code":"250","type":"RC"},{"code":"69312","type":"CPT","modifier":"19"}],"standard_charges":[{"setting":"outpatient","modifier_code":["19"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bumetanide Inj [1 Mg/4 Ml]","code_information":[{"code":"3000050","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cl-phenergan (Promethazine)25mg","code_information":[{"code":"3000101","type":"CDM"},{"code":"636","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dexamethasone 10mg/ml","code_information":[{"code":"3000137","type":"CDM"},{"code":"250","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Duloxetine Cap [30 Mg]","code_information":[{"code":"3000153","type":"CDM"},{"code":"250","type":"RC"},{"code":"23240","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Hydrocodone/acetaminophen 5mg/325mg","code_information":[{"code":"3000206","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687039601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ivermectin Oral Tablet 3mg","code_information":[{"code":"3000230","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Methylprednisolone Inj [125 Mg]","code_information":[{"code":"3000262","type":"CDM"},{"code":"636","type":"RC"},{"code":"90047","type":"CPT","modifier":"26"}],"standard_charges":[{"setting":"outpatient","modifier_code":["26"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Nicotine Transdermal Patch [21 Mg/24 Hr]","code_information":[{"code":"3000298","type":"CDM"},{"code":"250","type":"RC"},{"code":"37205035874","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Silvadene 1% Cream25 Gm Tube","code_information":[{"code":"3000353","type":"CDM"},{"code":"250","type":"RC"},{"code":"61570013155","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Xylocaine 2% Jelly","code_information":[{"code":"3000416","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Afrin Original 15ml","code_information":[{"code":"3000427","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP3000427","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cl-ethyl Chloride Mist","code_information":[{"code":"3000450","type":"CDM"},{"code":"250","type":"RC"},{"code":"38600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polocaine-mpf Sf 2% 20mg/ml","code_information":[{"code":"3000454","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dest Premal Lesion 2-14","code_information":[{"code":"8017003","type":"CDM"},{"code":"521","type":"RC"},{"code":"17003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Collection Specimen","code_information":[{"code":"8099000","type":"CDM"},{"code":"300","type":"RC"},{"code":"99000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Vfc-adacel (Tdap)0.5ml","code_information":[{"code":"3000388","type":"CDM"},{"code":"636","type":"RC"},{"code":"49281040015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-bexsero 0.5ml","code_information":[{"code":"3000389","type":"CDM"},{"code":"250","type":"RC"},{"code":"46028011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-daptacel (Dtap 6wks-6yrs)","code_information":[{"code":"3000390","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281028610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Vfc-flulaval Quadrivalent Syringe 0.5 Ml","code_information":[{"code":"3000391","type":"CDM"},{"code":"636","type":"RC"},{"code":"19515090652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-fluzone Pediatric Suspension 0.25 Ml","code_information":[{"code":"3000392","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281011325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Vfc-fluzone Quadrivalent","code_information":[{"code":"3000393","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281001488","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vfc-gardasil (Human Papillomavirus Quad)","code_information":[{"code":"3000394","type":"CDM"},{"code":"250","type":"RC"},{"code":"64045","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vfc-gardasil 9","code_information":[{"code":"3000395","type":"CDM"},{"code":"250","type":"RC"},{"code":"64119","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Vfc-hepatitis A Vaccine Ped (Havrix)","code_information":[{"code":"3000396","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vfc-hepatitis B Vial 5 Mcg","code_information":[{"code":"3000397","type":"CDM"},{"code":"250","type":"RC"},{"code":"64981","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Vfc-hib  Vial 0.5 Ml","code_information":[{"code":"3000398","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281054505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-ipol  Injectable 0.5 Ml","code_information":[{"code":"3000399","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281086010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-kinrix (Dtap Ipv) Susp 0.5ml","code_information":[{"code":"3000400","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-meningococcal Vial 0.5ml","code_information":[{"code":"3000401","type":"CDM"},{"code":"250","type":"RC"},{"code":"46028020801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-mmr Inj 0.5ml","code_information":[{"code":"3000402","type":"CDM"},{"code":"250","type":"RC"},{"code":"64681","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-pediarix (Dtap Hep B Ipv)0.5ml","code_information":[{"code":"3000403","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-pentacel (Dtap Ipv Hib)0.5ml","code_information":[{"code":"3000404","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281051005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-prevnar 13","code_information":[{"code":"3000405","type":"CDM"},{"code":"636","type":"RC"},{"code":"51971","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Vfc-proquad (Mmr Varicella)","code_information":[{"code":"3000406","type":"CDM"},{"code":"636","type":"RC"},{"code":"64999","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vfc-rotateq (Rvirus Vac Live)2ml","code_information":[{"code":"3000407","type":"CDM"},{"code":"250","type":"RC"},{"code":"64047","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Vfc-varivax (Varicella)0.5ml","code_information":[{"code":"3000408","type":"CDM"},{"code":"250","type":"RC"},{"code":"64827","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Vfc-prevnar 20","code_information":[{"code":"3000447","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":17,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Suture Vicryl P-3 4-0 12/bx","code_information":[{"code":"2580537","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580537","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Suture Br Black P-1 6-0 12/bx","code_information":[{"code":"2580541","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580541","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Cath Foley 22fr 5cc 2 Way Latex 12/cs","code_information":[{"code":"2584058","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Portex Single Use Bougie Introducer 15fr","code_information":[{"code":"2589903","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589903","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Pt Ultraviolet Light","code_information":[{"code":"6197028","type":"CDM"},{"code":"270","type":"RC"},{"code":"97028","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Pta Ultraviolet Light","code_information":[{"code":"6197029","type":"CDM"},{"code":"270","type":"RC"},{"code":"97028","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":16,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Pmc Sed Rate","code_information":[{"code":"8085651","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Xpiggyback Secondary Set 48/cs","code_information":[{"code":"2500030","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2500030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Ethilon Ps-2 5-0 36/bx","code_information":[{"code":"2580129","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Silk P-1 6-0 12/bx","code_information":[{"code":"2580133","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580133","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Small C-collar Lo Contour 13  X 15","code_information":[{"code":"2580137","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580137","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Vicryl Ps-2 3-0 12/bx","code_information":[{"code":"2580530","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580530","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Drainage Bag Closed Urinary","code_information":[{"code":"2580566","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580566","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Lo Contour Collar 3 Inch X20 5 Inch Xl","code_information":[{"code":"2580579","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Ethilon P-3 4-0 36/bx","code_information":[{"code":"2580617","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580617","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Cath Foley 18fr 5cc 2 Way Latex 12/cs","code_information":[{"code":"2584057","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"C-collar Lo Contour 3  17  X 19  Lg","code_information":[{"code":"2584092","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2584092","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Ethilon Silk 2-0 Ps-2 36/bx","code_information":[{"code":"2585020","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Gripper Power Pac Needle 20x1  (Huber","code_information":[{"code":"2585040","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Gripper Needle 20x1  ?Huber 90 Degree Rt","code_information":[{"code":"2585046","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585046","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Cath Leg Strap 2 X24  (Replaces H8410316","code_information":[{"code":"2586206","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586206","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Lo Contour Cervical 15-17 Inch Md","code_information":[{"code":"2586235","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586235","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Pill Crusher","code_information":[{"code":"2586803","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP2586803","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cath Urinary 8 Fr 2 Way 3cc","code_information":[{"code":"2587020","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Suture Ethilon Black Mono 3-0 Ps-1","code_information":[{"code":"2587036","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Foley Cath 12fr","code_information":[{"code":"2589744","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589744","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Plain Packing Strip 1/4  X 5yd Substitut","code_information":[{"code":"2589836","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Packing Strips 1/2 X5yds Substution Item","code_information":[{"code":"2589837","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589837","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Limb Restraints Holder Univ 1 Pair","code_information":[{"code":"2589857","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589857","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Gripper Needle 20x1  (Huber 90 Degree Rt","code_information":[{"code":"2589870","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589870","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Deroyal Child Sling","code_information":[{"code":"2589884","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589884","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Ted Stocking 2x Thigh Regular Length","code_information":[{"code":"2589920","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Crestor 10 Mg","code_information":[{"code":"3000129","type":"CDM"},{"code":"250","type":"RC"},{"code":"58016003730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ketorolac Inj [60 Mg/2 Ml]","code_information":[{"code":"3000233","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Oxygen Per Hour","code_information":[{"code":"6700037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP6700037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Butorphanol Tartrate 1 Mg","code_information":[{"code":"8070595","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Heparin 5 Ml","code_information":[{"code":"8071604","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Catheter Foley Secure Statlock Adult","code_information":[{"code":"2580144","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Delta-lite Cast Tape 3 Inch White","code_information":[{"code":"2580629","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580629","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Aloe Vesta 3 N 1 Clean Foam","code_information":[{"code":"2586073","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Suture Ethilon Bl 5-0 Ps-2 12/bx","code_information":[{"code":"2589718","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589718","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Intubation Stylet 7 5-10 10/cs","code_information":[{"code":"2589731","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589731","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Iodoform 1/4  Sub Item","code_information":[{"code":"2589844","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589844","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Calmoseptine Ointment","code_information":[{"code":"3000056","type":"CDM"},{"code":"250","type":"RC"},{"code":"79900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cl-depo-testosterone (T-cypio) 200mg","code_information":[{"code":"3000079","type":"CDM"},{"code":"250","type":"RC"},{"code":"90417","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Metoprolol Inj [5 Mg/5 Ml]","code_information":[{"code":"3000265","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Promethazine Supp [12.5 Mg]","code_information":[{"code":"3000339","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Seroquel 25 Mg","code_information":[{"code":"3000351","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":424,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":424},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lovenox 10 Mg","code_information":[{"code":"8071650","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"H1n1 Administration Only","code_information":[{"code":"8090470","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP8090470","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Aloe Vesta 2n1 Antifungal Oint","code_information":[{"code":"2580571","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580571","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Quick Step Splint 3x15'","code_information":[{"code":"2585000","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"7.0mm  Sheritan Oral/nasal Endotracheal","code_information":[{"code":"2585007","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"8.5 Mm  Sheritan Oral/nasal Endotracheal","code_information":[{"code":"2585008","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Iodoform 1/4x5 Packing","code_information":[{"code":"2585010","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"8.0mm Endo Trach Tube 10/bx","code_information":[{"code":"2585012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"3.0mm Endo Trach Tube 10/bx","code_information":[{"code":"2585013","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"2.0mm Endo Trach Tube","code_information":[{"code":"2585014","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"3  Bsn Dynacast Fiberglass Splint 15'","code_information":[{"code":"2585045","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"4  Elastic Novaplus Bandage","code_information":[{"code":"2586005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Allevyn Wound Dressing 3 X 3","code_information":[{"code":"2586277","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586277","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Endo Tube 3.0 W/ Cuff 10/bx","code_information":[{"code":"2589746","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589746","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Suture Ethilon Black 6-0 P-3 12/bx","code_information":[{"code":"2589839","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589839","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Suture3-0 Ethilon Ps-2 Black 36/bx","code_information":[{"code":"2589843","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"10fr Pedi Foley Cetheter 2way 3cc","code_information":[{"code":"2589894","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589894","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"8.0mm Shiley Hi-lo Oral/nasal Endotrache","code_information":[{"code":"2589941","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589941","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"6.5mm Shiley Hi-lo Oral Nasal Endotrache","code_information":[{"code":"2589942","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589942","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"4.5mm Shiley Hi-lo Oral/nasal Endotrache","code_information":[{"code":"2589943","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"5.5mm Shiley Hi-lo Oral/nasal Endotrache","code_information":[{"code":"2589944","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589944","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"4.0 Shiley Hi-lo Oral/nasal Endotracheal","code_information":[{"code":"2589945","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589945","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"5.0mm Shiley Hi-lo Oral/hasal Endotrache","code_information":[{"code":"2589946","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589946","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"3.0 Shiley Hi-lo Oral/nasal Endotracheal","code_information":[{"code":"2589989","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"6.0 Shiley Hi-lo Oral/nasal Endotracheal","code_information":[{"code":"2589990","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"3.5 Shiley Hi-lo Oral/nasal Endotracheal","code_information":[{"code":"2589991","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"3  Scotchcast Quick Step Splint 15'","code_information":[{"code":"2589997","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Surgilast Tube Elastic Net Bandage Sz4","code_information":[{"code":"2589998","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Surgilast Tube Elastic Net Bandage Sz3","code_information":[{"code":"2589999","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Cl-rocephin 250mg","code_information":[{"code":"3000105","type":"CDM"},{"code":"636","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cl-rocephin 250 Mg","code_information":[{"code":"3000106","type":"CDM"},{"code":"636","type":"RC"},{"code":"78193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Eliquis 2.5 Mg","code_information":[{"code":"3000157","type":"CDM"},{"code":"250","type":"RC"},{"code":"30893","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Zithromax 500mg Tab","code_information":[{"code":"3000420","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Blood Draw","code_information":[{"code":"8036415","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":30,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Rocephin 250 Mg","code_information":[{"code":"8070696","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Morphine Sulfate Up To 10mg","code_information":[{"code":"8072270","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Tegaderm Hydrocolliod 2 75  X 4 34","code_information":[{"code":"2580141","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Deroyal Skin Stapler 35 Regular","code_information":[{"code":"2585039","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Rt Angle Infusion Set 20g 1 Inch W/y Sit","code_information":[{"code":"2586195","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586195","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Ear Wicks 1-size Prepackaged","code_information":[{"code":"2586288","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Tourni Cot Finger Tourniquet Mixed Box","code_information":[{"code":"2589785","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589785","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Foley Securment Statlock Treco Pad","code_information":[{"code":"2589871","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589871","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Precise Skin Stapler 35 Wide","code_information":[{"code":"2589921","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589921","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"3m Skin Stapler 35 Wide","code_information":[{"code":"2589995","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589995","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Skin Stapler Remover","code_information":[{"code":"2589996","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589996","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Azithromycin Susp [100 Mg/5 Ml]","code_information":[{"code":"3000040","type":"CDM"},{"code":"250","type":"RC"},{"code":"93202","type":"CPT","modifier":"723"}],"standard_charges":[{"setting":"outpatient","modifier_code":["723"],"minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clonidine Patch [0.1 Mg/24 Hr]","code_information":[{"code":"3000122","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907002348","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nicotine Transdermal Patch 14 Mg/24 Hr","code_information":[{"code":"3000299","type":"CDM"},{"code":"250","type":"RC"},{"code":"37205036174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Dilaudid 1mg","code_information":[{"code":"3000431","type":"CDM"},{"code":"636","type":"RC"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hydromorphone Hydrochloride Tab [2 Mg]","code_information":[{"code":"3000440","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nf-afrin Nasal Spray 0.05%","code_information":[{"code":"3060888","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523116703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tetracycline","code_information":[{"code":"8070120","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lasix 40 Mg/ 4cc","code_information":[{"code":"8071940","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Demerol 50mg Inj","code_information":[{"code":"8072180","type":"CDM"},{"code":"250","type":"RC"},{"code":"J2180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Blood test, clotting time","code_information":[{"code":"8085610","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":32,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Allergy Skin Testing","code_information":[{"code":"8095004","type":"CDM"},{"code":"521","type":"RC"},{"code":"95004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Promethazine Hcl 25mg Supp","code_information":[{"code":"3000336","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Suture Prolene Ct-2 2-0 36/bx","code_information":[{"code":"2580540","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580540","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Catheter 24fr 30cc Foley Sili","code_information":[{"code":"2580567","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580567","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Voldyne 5000 Breath Exerciser","code_information":[{"code":"2584024","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Meplix Ag All In One 4x12 Dressing","code_information":[{"code":"2585027","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Pill Splitter","code_information":[{"code":"2586802","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP2586802","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Meplix Lite 4x4 Dressing","code_information":[{"code":"2589775","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589775","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Int Stylet 6fr Fit 2 5-4 5 Slick Pediatr","code_information":[{"code":"2589812","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589812","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Sterile Water For Inhalation 1000ml 12/c","code_information":[{"code":"2589957","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589957","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nf-entresto Oral Tablet 24mg-26mg","code_information":[{"code":"3060743","type":"CDM"},{"code":"250","type":"RC"},{"code":"78065","type":"CPT","modifier":"961"}],"standard_charges":[{"setting":"outpatient","modifier_code":["961"],"minimum":11,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Pmc Hemoccult","code_information":[{"code":"8082272","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Endo Tube 8.0 W/cuff","code_information":[{"code":"2580127","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580127","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 7.5mm W/cuff","code_information":[{"code":"2584005","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Dermaflex Qs Wound Closure","code_information":[{"code":"2584041","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 8.5mm W/ Cuff 10/bx","code_information":[{"code":"2584070","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584070","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 6.55mm W/ Cuff 10/bx","code_information":[{"code":"2584071","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584071","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 4.0mm W/ Cuff 10/bx","code_information":[{"code":"2584074","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584074","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 4.5mm W/ Cuff 10/bx","code_information":[{"code":"2584075","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 5.0mm W/ Cuff 10/bx","code_information":[{"code":"2584076","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Xendo Tube 6.0mm W/ Cuff 10/bx","code_information":[{"code":"2584077","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Skin Staple Remover Stainless Steel","code_information":[{"code":"2585051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 7.0mm W/cuff","code_information":[{"code":"2586310","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586310","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Humidifier Prefill Aqua Pak 650ml 10/cs","code_information":[{"code":"2586589","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586589","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Skin Staple Remover/tweezer","code_information":[{"code":"2586751","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Endo Tube 5.5mm W/cuff","code_information":[{"code":"2589754","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Adaptic Non-adhering Dressing 5 X9  12/b","code_information":[{"code":"2589914","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589914","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Peep Valve","code_information":[{"code":"2589947","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589947","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Urinalysis test","code_information":[{"code":"8081002","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Pmc Blood Glucose Monitoring","code_information":[{"code":"8082962","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":11,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Ext Set Large Bore 32  48/cs","code_information":[{"code":"2500033","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP2500033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Microbore 8  Extension Set","code_information":[{"code":"2500042","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2500042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Mediplast 2  X 3","code_information":[{"code":"2580120","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Toad Finger Splint Med 12/bx","code_information":[{"code":"2580501","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580501","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Toad Finger Splint Sm 12/bx","code_information":[{"code":"2580502","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580502","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Toad Finger Splint Lg 12/bx","code_information":[{"code":"2580503","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Suture Silk Sh 3-0 26/bx","code_information":[{"code":"2580557","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580557","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Suture Vicryl Fs-2 3-0 36/bx","code_information":[{"code":"2580559","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580559","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Packing Strip Iodoform 1/4x5","code_information":[{"code":"2584001","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Enema Bucket W/ Soap 50/cs","code_information":[{"code":"2584087","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584087","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"3  Elastic Novaplus Bandage","code_information":[{"code":"2586007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"2  Elastic Novaplus Bandage","code_information":[{"code":"2586009","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Urinary Cath Plug Small(replaces 2221)12","code_information":[{"code":"2586211","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Iodoform 5  Packing Strips","code_information":[{"code":"2587001","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Pvc Nasal Airway 22 Fr","code_information":[{"code":"2589725","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589725","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Sm 4 5 Finger Splint Baseball 12/bx","code_information":[{"code":"2589865","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589865","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Med Finger Splint 4 75  Basebal 12/bx","code_information":[{"code":"2589866","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Lg 5 75  Fingersplint Baseball 12/bx","code_information":[{"code":"2589867","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589867","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Infant Foley Catheter Kit 5fr","code_information":[{"code":"2589925","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589925","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Nasopharyngeal Airway 18fr","code_information":[{"code":"2589936","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589936","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Nasopharyngeal Airway 16fr","code_information":[{"code":"2589937","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Nasopharyngeal Airway 20fr","code_information":[{"code":"2589938","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Sterile Irrigation Piston Syringe Tray","code_information":[{"code":"2589939","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589939","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Cephalexin Susp [250 Mg/5 Ml-100 Ml]","code_information":[{"code":"3000065","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180044101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Heparin Lock Flush Inj [100 Units/ml]","code_information":[{"code":"3000202","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807060055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Iv Nacl 0.9%  Flush [10 Ml]","code_information":[{"code":"3000225","type":"CDM"},{"code":"270","type":"RC"},{"code":"63807010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Losartan Tab [50 Mg]","code_information":[{"code":"3000252","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268051715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Normal Saline (10ml Syring) Flush","code_information":[{"code":"3000303","type":"CDM"},{"code":"270","type":"RC"},{"code":"8290306546","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Water Bact Inj [10 Ml]","code_information":[{"code":"3000411","type":"CDM"},{"code":"250","type":"RC"},{"code":"40939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Water Sterile Inj [20 Ml]","code_information":[{"code":"3000412","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Vitamin K 10 Mg Injection","code_information":[{"code":"8073430","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":10,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Rusch Pvc Nasal Airway 20fr","code_information":[{"code":"2585044","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"2.0mm Endo Trach Tube Uncuffed 10/bx","code_information":[{"code":"2589859","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589859","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Amoxicillin Susp 125mg/5ml","code_information":[{"code":"3000028","type":"CDM"},{"code":"250","type":"RC"},{"code":"78160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Bisacodyl Supp [10 Mg]","code_information":[{"code":"3000048","type":"CDM"},{"code":"250","type":"RC"},{"code":"71301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cl-kenalog (Triamcinolone Acet)","code_information":[{"code":"3000094","type":"CDM"},{"code":"636","type":"RC"},{"code":"30293","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kenalog 40mg/ml","code_information":[{"code":"3000231","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121116901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ondansetron 2mg/1ml","code_information":[{"code":"3000309","type":"CDM"},{"code":"636","type":"RC"},{"code":"40947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pantoprazole Tab [40 Mg]","code_information":[{"code":"3000317","type":"CDM"},{"code":"250","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sodium Polystyrene Sulfonate","code_information":[{"code":"3000358","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide Oint","code_information":[{"code":"3000419","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toradol 15 Mg","code_information":[{"code":"8071885","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Kenalog 40 Mg","code_information":[{"code":"8073301","type":"CDM"},{"code":"636","type":"RC"},{"code":"30293","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Kenalog 80 Mg","code_information":[{"code":"8073302","type":"CDM"},{"code":"636","type":"RC"},{"code":"30315","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"7  Macrobore Ext Set 50/cs","code_information":[{"code":"2500043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2500043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Blood Tubing 200 Micron Filter 36  48/cs","code_information":[{"code":"2500044","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2500044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Suture Ethilon Fs-1 4-0 36/bx","code_information":[{"code":"2580561","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580561","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Soft Pvc Airway Kit 12-18fr","code_information":[{"code":"2584013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Pvc Nasal Airway 20fr","code_information":[{"code":"2584014","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Female Cath Kit 8 Fr L/f 25/bx 4bx/cs","code_information":[{"code":"2584060","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Triad Hydrophilic Wound Cream 6oz","code_information":[{"code":"2585043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Leg Bag Large 32 Oz","code_information":[{"code":"2586225","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586225","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Packing Strips 1/2 Inch Plain","code_information":[{"code":"2586560","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586560","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Readi-cat 2 Barium Sulfate Sus Orange Va","code_information":[{"code":"2586801","type":"CDM"},{"code":"255","type":"RC"},{"code":"CP2586801","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Tube Salem Sump 16fr X 48 Inch","code_information":[{"code":"2586900","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Suture Silk Fs-1 3-0 12/bx","code_information":[{"code":"2587033","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ng Tube Holder","code_information":[{"code":"2589724","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589724","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Salem Sump 14fr","code_information":[{"code":"2589738","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589738","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Salem Sump 10 Fr","code_information":[{"code":"2589739","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Enternal Nutrition Ezf Bag Set","code_information":[{"code":"2589749","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589749","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Invalid Cushion 20/cs","code_information":[{"code":"2589752","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589752","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Flex-slip Stylet 10fr 44cm","code_information":[{"code":"2589781","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589781","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Airway Pvc Nasal 18fr 10/bx","code_information":[{"code":"2589881","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589881","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cast Tape Delta-lite Wite 2  X 12' 10/bx","code_information":[{"code":"2589895","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589895","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Allevyn Gentle Border Dressing 4x4 10/bx","code_information":[{"code":"2589905","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589905","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"18fr 30cc 2-way Bardex Catheter","code_information":[{"code":"2589988","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Escitalopram Tab [10 Mg]","code_information":[{"code":"3000164","type":"CDM"},{"code":"250","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Stax Finger Splint Sz 2","code_information":[{"code":"2580109","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 3","code_information":[{"code":"2580110","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 5 5","code_information":[{"code":"2580111","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Aloe Vesta 2 N 1 Protect Oint","code_information":[{"code":"2580539","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580539","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 1","code_information":[{"code":"2580544","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580544","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 4","code_information":[{"code":"2580547","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580547","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 5","code_information":[{"code":"2580548","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580548","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 6","code_information":[{"code":"2580549","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580549","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Stax Finger Splint Sz 7","code_information":[{"code":"2580551","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580551","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Endo Tube 3.5mm W/out Cuff 10/bx","code_information":[{"code":"2584073","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Suction Cath Tray 14fr 24/cs","code_information":[{"code":"2584086","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2584086","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Endo Tube 3.5mm W/ Cuff 10/bx","code_information":[{"code":"2585016","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Eco Suction Canister 1500cc","code_information":[{"code":"2585021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2585021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Suction Canister 1500cc","code_information":[{"code":"2586798","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586798","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Endo Tube 2.0 W/o Cuff 10/bx D/c","code_information":[{"code":"2589747","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589747","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Sher-i-slip Adult Stylet","code_information":[{"code":"2589889","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589889","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Yankauer Suction Bulbous With On/off Swi","code_information":[{"code":"2589961","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589961","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Albuterol Neb Soln [2.5 Mg/3 Ml]","code_information":[{"code":"3000015","type":"CDM"},{"code":"250","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Albuterol Sulfate Inhalation Soln 0.5%","code_information":[{"code":"3000016","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208034720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cl-benadryl (Diphenhydramine)50mg","code_information":[{"code":"3000074","type":"CDM"},{"code":"636","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Gentamicin 0.3% Ophth Drops","code_information":[{"code":"3000188","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Levalbuterol Neb Soln [1.25 Mg]","code_information":[{"code":"3000238","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402051530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Prednisolone Soln 5mg/5ml","code_information":[{"code":"3000331","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383004004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Benadryl Injection","code_information":[{"code":"8071200","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pmc Hemoglobin","code_information":[{"code":"8085018","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Blood Secondary Set 48/cs","code_information":[{"code":"2500031","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP2500031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Finger Splint 5  X 18  12/bx","code_information":[{"code":"2580527","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2580527","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Finger Splint 75  X 18  12/bx","code_information":[{"code":"2580563","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580563","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Xmicro Mist Nebulizer Sm Volume Ped Mask","code_information":[{"code":"2580627","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580627","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Resmed Vent Tubing Dbl S/bore 15mm","code_information":[{"code":"2585023","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2585023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Finger Splint 1 5  X 18  (Replaces 9115-","code_information":[{"code":"2586371","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2586371","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Micro Mist Nebulizer Pipe Adult Setup","code_information":[{"code":"2586553","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586553","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Tielle 2 75 X 3 5 Moderate Absorbant Dre","code_information":[{"code":"2589091","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589091","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Face Sheild Cpr Disp Foil Pouch","code_information":[{"code":"2589751","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Barrier Sheild Cloth Comfort Bath 8/pk 4","code_information":[{"code":"2589827","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Extension Set Lf Micb T Pp Inj(cardiac R","code_information":[{"code":"2589828","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2589828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Tegaderm 6x8 Frame Style 10/bx","code_information":[{"code":"2589885","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589885","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Dermabond Advanced Adhesive 0 7ml 12/bx","code_information":[{"code":"2589899","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589899","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Dctielle Foam Dressing Border 2 75 X3 5","code_information":[{"code":"2589922","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589922","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"7.5 Et Tune Sheridan/hvt 10/bx","code_information":[{"code":"2589924","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Flomax 0.4  Cap","code_information":[{"code":"3000174","type":"CDM"},{"code":"250","type":"RC"},{"code":"90473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":31,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Levetiracetam Tab [500 Mg]","code_information":[{"code":"3000239","type":"CDM"},{"code":"250","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":31,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metronidazole 500 Mg Tab","code_information":[{"code":"3000267","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155006501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sucralfate Susp 1 Gm/10 Ml-120 Ml]","code_information":[{"code":"3000362","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Nf-alprazolam       Tab  1mg","code_information":[{"code":"3060952","type":"CDM"},{"code":"250","type":"RC"},{"code":"61919000630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ls Clave Port M-adapt Plug Ll 100/cs","code_information":[{"code":"2500038","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2500038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Specialist J-splint 4 Inch X 20'","code_information":[{"code":"2580106","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Scotchcast Formable Roll Splint 2rl/cs","code_information":[{"code":"2580114","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Steri Strip 5  X 4  6/pk 50pk/bx","code_information":[{"code":"2580533","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580533","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Sodium Chloride 0.9% 500ml Irr Btl","code_information":[{"code":"2580564","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Ndc Sodium Chloride 0.9% 250ml","code_information":[{"code":"2585037","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Baxter Sterile Water 500ml Irr","code_information":[{"code":"2585038","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Irrigation Tray W/piston Syr","code_information":[{"code":"2586457","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586457","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Sterile Water F/irrig 500ml","code_information":[{"code":"2586463","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586463","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Alum 4 Prong Finger Spint Small","code_information":[{"code":"2587004","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2587004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Alum 4 Prong Finger Splint Lg","code_information":[{"code":"2587006","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2587006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Alum 4 Prong Finger Splint Med","code_information":[{"code":"2587026","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2587026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Gauze Sponge 4x4 St 10's 12 Ply","code_information":[{"code":"2589713","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589713","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Feeding Tube 8 Fr","code_information":[{"code":"2589741","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589741","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Guaze Sponge 2x2 8 Ply N/s 200/pack","code_information":[{"code":"2589753","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589753","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Guaze Sponge 4x4 12 Ply Sterile 10/tray","code_information":[{"code":"2589824","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589824","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Aqua Pak Prefilled O2 Humidity 340ml Ste","code_information":[{"code":"2589882","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589882","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Salem Sump Tube 10fr 36  St 50/cs","code_information":[{"code":"2589913","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589913","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"18fr Salem Sump Tube","code_information":[{"code":"2589916","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589916","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Nebulizer Updraft Ii Opti Neb Mask 50/cs","code_information":[{"code":"2589934","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589934","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Cl-dexamethasone 4mg/ml","code_information":[{"code":"3000117","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Clotrimazole 30gm (30gm Tube)","code_information":[{"code":"3000125","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Decadron 6mg Tab","code_information":[{"code":"3000133","type":"CDM"},{"code":"250","type":"RC"},{"code":"54418","type":"CPT","modifier":"625"}],"standard_charges":[{"setting":"outpatient","modifier_code":["625"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Fleets Enema","code_information":[{"code":"3000173","type":"CDM"},{"code":"270","type":"RC"},{"code":"53674","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Guaifenesin/dext Liq [200-10 Mg/5 Ml]","code_information":[{"code":"3000196","type":"CDM"},{"code":"250","type":"RC"},{"code":"54838020980","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydrocortisone 1% Cream","code_information":[{"code":"3000207","type":"CDM"},{"code":"250","type":"RC"},{"code":"60305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levalbuterol Neb Soln [0.63 Mg]","code_information":[{"code":"3000237","type":"CDM"},{"code":"250","type":"RC"},{"code":"93414","type":"CPT","modifier":"664"}],"standard_charges":[{"setting":"outpatient","modifier_code":["664"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":63,"type":"ME"}},{"description":"Nystatin Susp [100,000 Unit]","code_information":[{"code":"3000305","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432053716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Pravastatin 40 Mg Tab","code_information":[{"code":"3000329","type":"CDM"},{"code":"250","type":"RC"},{"code":"84386003390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Venlafaxine Xr Cap [37.5 Mg]","code_information":[{"code":"3000387","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Warfarintab [5 Mg]","code_information":[{"code":"3000410","type":"CDM"},{"code":"250","type":"RC"},{"code":"62584099411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Depomedrol 20 Mg","code_information":[{"code":"8071020","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Stopcock 3 Way","code_information":[{"code":"800037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP800037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Pigggyback Tubing D/c 50/cs","code_information":[{"code":"2500036","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP2500036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Suction Tubing 6mmx10' Str","code_information":[{"code":"2580100","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Tegaderm Iv 2 3/8 Inchx2 3/4 Inch 50/bx","code_information":[{"code":"2584010","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Steri-strip Closure 1/4 Inch X 4 Inch","code_information":[{"code":"2584012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Aquacel Ag Ribbon 1x45cm Rope Dressing","code_information":[{"code":"2585005","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Aquacel Ag Ribbon 2x45cm Rope Dressing","code_information":[{"code":"2585006","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Nebulizer Ped Withmask & 7'tube","code_information":[{"code":"2585009","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Yankauer Suction Bulbous","code_information":[{"code":"2586800","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2586800","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Nitro Sec (Piggyback)","code_information":[{"code":"2589714","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2589714","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"4x4 St Guaze 2/pk 25pk/bx(sub Item)","code_information":[{"code":"2589838","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589838","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"1/2  X 72  Vaseline Gauze 12/pk","code_information":[{"code":"2589868","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589868","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Gauze Tubular Inf 1 125 X50yrds Sz 2ap","code_information":[{"code":"2589933","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589933","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"20fr 30cc 2-way Silicone Catheter","code_information":[{"code":"2589986","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Emergency Cricothyroidotomy Kit","code_information":[{"code":"2589992","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Acetaminophen Liq [160 Mg/5 Ml]","code_information":[{"code":"3000001","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580042401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Acetaminophen Supp Adult [650 Mg]","code_information":[{"code":"3000003","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophen Supp Child [120 Mg]","code_information":[{"code":"3000004","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Acetaminophen Tab [325 Mg]","code_information":[{"code":"3000005","type":"CDM"},{"code":"250","type":"RC"},{"code":"90419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Acetaminophen Tab [500 Mg]","code_information":[{"code":"3000006","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896022101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetaminophen/codeine 300/30","code_information":[{"code":"3000007","type":"CDM"},{"code":"250","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Albuterol/ Ipratropium  Neb Soln","code_information":[{"code":"3000018","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097084064","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allopurinol Tab [100 Mg]","code_information":[{"code":"3000019","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079020520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Alum Hydroxide-magnes Hydroxide-","code_information":[{"code":"3000020","type":"CDM"},{"code":"250","type":"RC"},{"code":"37205053540","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone Tab [200 Mg]","code_information":[{"code":"3000023","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687043701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Amoxicil/ Pot Clav Tab 875/125 Mg","code_information":[{"code":"3000025","type":"CDM"},{"code":"250","type":"RC"},{"code":"93227","type":"CPT","modifier":"534"}],"standard_charges":[{"setting":"outpatient","modifier_code":["534"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amoxicillin Cap [500 Mg]","code_information":[{"code":"3000026","type":"CDM"},{"code":"250","type":"RC"},{"code":"78126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Atenolol Tab [25 Mg]","code_information":[{"code":"3000035","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862016801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atorvastatin 40 Mg","code_information":[{"code":"3000036","type":"CDM"},{"code":"250","type":"RC"},{"code":"90462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Benazepril Tab [10 Mg]","code_information":[{"code":"3000044","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155075001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Benzonatate Cap [100 Mg]","code_information":[{"code":"3000047","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806071401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bisacodyl Tab [5 Mg]","code_information":[{"code":"3000049","type":"CDM"},{"code":"250","type":"RC"},{"code":"90479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bupropion Sr Tab [150 Mg]","code_information":[{"code":"3000053","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Captopril Tab 25 Mg","code_information":[{"code":"3000057","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079086420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cefuroxime Tab [250 Mg]","code_information":[{"code":"3000063","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cephalexin Cap 250 Mg","code_information":[{"code":"3000064","type":"CDM"},{"code":"250","type":"RC"},{"code":"93314","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cetirizine Tab [10 Mg]","code_information":[{"code":"3000066","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ciprofloxacin Tab [500 Mg]","code_information":[{"code":"3000067","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079018220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Citalopram Tab [10 Mg]","code_information":[{"code":"3000069","type":"CDM"},{"code":"250","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":31,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cl-zofran 4mg/2ml","code_information":[{"code":"3000115","type":"CDM"},{"code":"636","type":"RC"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Clindamycin Cap [150 Mg]","code_information":[{"code":"3000121","type":"CDM"},{"code":"250","type":"RC"},{"code":"90459","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clonidine Tab [0.1 Mg]","code_information":[{"code":"3000123","type":"CDM"},{"code":"250","type":"RC"},{"code":"22821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clopidogrel Tab [75 Mg]","code_information":[{"code":"3000124","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Deltasone Tab 10 Mg","code_information":[{"code":"3000134","type":"CDM"},{"code":"636","type":"RC"},{"code":"59651048701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dexamethasone Syrup [0.5 Mg/5 Ml]","code_information":[{"code":"3000138","type":"CDM"},{"code":"250","type":"RC"},{"code":"54317","type":"CPT","modifier":"757"}],"standard_charges":[{"setting":"outpatient","modifier_code":["757"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diltiazem Cd Cap [120 Mg]","code_information":[{"code":"3000142","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742024830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Diltiazem Tab 30 Mg","code_information":[{"code":"3000143","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228048101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diphenhydramine  Tab[25 Mg]","code_information":[{"code":"3000144","type":"CDM"},{"code":"250","type":"RC"},{"code":"90453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diphenhydramine Elix 12.5mg/5ml","code_information":[{"code":"3000145","type":"CDM"},{"code":"250","type":"RC"},{"code":"60308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Divalproex Tab 125 Mg","code_information":[{"code":"3000147","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237010601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Doxycycline Cap 100 Mg","code_information":[{"code":"3000152","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluoxetine Cap [20 Mg]","code_information":[{"code":"3000179","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Furosemide Tab [20 Mg]","code_information":[{"code":"3000185","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Gabapentin Cap [300 Mg]","code_information":[{"code":"3000187","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Glimepiride (Amaryl) 1 Mg","code_information":[{"code":"3000191","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111032001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hydralazine Tab 25 Mg","code_information":[{"code":"3000204","type":"CDM"},{"code":"250","type":"RC"},{"code":"90474","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":23,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrochlorothiazide Tab [25 Mg]","code_information":[{"code":"3000205","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Labetalol Inj [100 Mg/20 Ml]","code_information":[{"code":"3000234","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lactulose Liq [10 Gm/15 Ml]","code_information":[{"code":"3000235","type":"CDM"},{"code":"250","type":"RC"},{"code":"60313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Lansoprazole Cap [30 Mg]","code_information":[{"code":"3000236","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lisinopril Tab [10 Mg]","code_information":[{"code":"3000246","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180098001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Losartan Potassium/hctz 100/25 Mg","code_information":[{"code":"3000251","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lovastatin (Mevacor) 10 Mg","code_information":[{"code":"3000253","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180046707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Magnesium Citrate Saline Laxative","code_information":[{"code":"3000254","type":"CDM"},{"code":"250","type":"RC"},{"code":"36301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin Tab [500 Mg]","code_information":[{"code":"3000260","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010006301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metolazone Tab [5 Mg]","code_information":[{"code":"3000264","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metoprolol Tar Tab [50 Mg]","code_information":[{"code":"3000266","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332011331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Mirtazapine (Remeron) 15 Mg","code_information":[{"code":"3000272","type":"CDM"},{"code":"250","type":"RC"},{"code":"93720","type":"CPT","modifier":"656"}],"standard_charges":[{"setting":"outpatient","modifier_code":["656"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nebivolol 5mg Tab","code_information":[{"code":"3000283","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547052503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nf Sodium Chloride 1 Gram Tablet","code_information":[{"code":"3000294","type":"CDM"},{"code":"250","type":"RC"},{"code":"22317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Nf Toprol Xl 25 Mg Tablet","code_information":[{"code":"3000296","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084065901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nitrostat Sl Tab [0.4 Mg]","code_information":[{"code":"3000300","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756001402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitro-transderm Patch [0.2 Mg/24 Hr]","code_information":[{"code":"3000301","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Omeprazole Cap [20 Mg]","code_information":[{"code":"3000308","type":"CDM"},{"code":"250","type":"RC"},{"code":"90456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxybutynin Tab [5 Mg]","code_information":[{"code":"3000313","type":"CDM"},{"code":"250","type":"RC"},{"code":"83200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenazopyridine Tab 100 Mg","code_information":[{"code":"3000319","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenytoin Susp [125 Mg/5 Ml]","code_information":[{"code":"3000320","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672406902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Polyethylene Glycol Powd [17 Gm]","code_information":[{"code":"3000324","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079030601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":17,"type":"GR"}},{"description":"Potassium Chl Oral Soln 10%","code_information":[{"code":"3000325","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888004113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Potassium Cl [20 Meq] Tab","code_information":[{"code":"3000326","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758019013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Potassium Cl Tab [10 Meq]","code_information":[{"code":"3000327","type":"CDM"},{"code":"250","type":"RC"},{"code":"83253","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Proamatine Tab [5 Mg]","code_information":[{"code":"3000332","type":"CDM"},{"code":"250","type":"RC"},{"code":"11542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Promethazine Tab [25 Mg]","code_information":[{"code":"3000340","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739021310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Saccharomyces Boulardii 250mg Pkt","code_information":[{"code":"3000349","type":"CDM"},{"code":"250","type":"RC"},{"code":"4142000024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Sertraline Tab [100 Mg]","code_information":[{"code":"3000352","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180035306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Silver Nitrate Stick","code_information":[{"code":"3000354","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Simvastatin Tab 10 Mg","code_information":[{"code":"3000355","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377000214","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Spironolactone Tab [25 Mg]","code_information":[{"code":"3000360","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sucralfate Tab [1 Gm]","code_information":[{"code":"3000363","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sulfameth/ Tmp Ds Tab [800-160 Mg]","code_information":[{"code":"3000365","type":"CDM"},{"code":"250","type":"RC"},{"code":"90427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Torsemide Tab [20 Mg]","code_information":[{"code":"3000375","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155087301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Trazodone Tab [50 Mg]","code_information":[{"code":"3000378","type":"CDM"},{"code":"250","type":"RC"},{"code":"90465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venlafaxine Er Cap [150 Mg]","code_information":[{"code":"3000386","type":"CDM"},{"code":"250","type":"RC"},{"code":"93738","type":"CPT","modifier":"656"}],"standard_charges":[{"setting":"outpatient","modifier_code":["656"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Warfarin Tab [1 Mg]","code_information":[{"code":"3000409","type":"CDM"},{"code":"250","type":"RC"},{"code":"93171","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diltiazem Cd Cap [180 Mg]","code_information":[{"code":"3000426","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP3000426","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Metoclopramide Tab [10 Mg]","code_information":[{"code":"3000435","type":"CDM"},{"code":"250","type":"RC"},{"code":"93220","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ibuprofen Tab [600 Mg]","code_information":[{"code":"3000449","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877032001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Nf-metoprolol Succinate Oral Tab Er 50mg","code_information":[{"code":"3060746","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037083110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nf-levothyroxine Sodium Liq Capsule 175m","code_information":[{"code":"3060806","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"EA"}},{"description":"Nf-levothyroxin Tab  75mcg","code_information":[{"code":"3060807","type":"CDM"},{"code":"250","type":"RC"},{"code":"50090090101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Nf-hydroxychloroquine Oral Tablet 200mg","code_information":[{"code":"3060836","type":"CDM"},{"code":"250","type":"RC"},{"code":"50090250801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Nf-levothyroxine Oral Tablet 50mcg","code_information":[{"code":"3060864","type":"CDM"},{"code":"250","type":"RC"},{"code":"54868213101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nf-temazepam Capsule 15mg","code_information":[{"code":"3060892","type":"CDM"},{"code":"250","type":"RC"},{"code":"78122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":214,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":214},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nf-prednisone Tablet 1mg","code_information":[{"code":"3061351","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746017106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Crmaintenance","code_information":[{"code":"6699999","type":"CDM"},{"code":"943","type":"RC"},{"code":"CP6699999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Epinephrine 0.1 Mg","code_information":[{"code":"8070171","type":"CDM"},{"code":"250","type":"RC"},{"code":"J0165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Zofran 1 Mg","code_information":[{"code":"8072405","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Stop Cock With Swivel","code_information":[{"code":"800036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP800036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Stopcock 3 Way D/c 50/cs","code_information":[{"code":"2500037","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2500037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Stopcock With Swivel","code_information":[{"code":"2500039","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2500039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Suction Tubing 6' Connecting 3/16 Inch","code_information":[{"code":"2580054","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Soft Rol Cast Padding 4  X 4yds","code_information":[{"code":"2580108","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suction Cath 14fr W/ Tip 100/cs","code_information":[{"code":"2580126","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2580126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Webril Cast Padding 3 In 4yds 12/pk 6pk/","code_information":[{"code":"2580128","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580128","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Steri Strip 25  X 3  3/pk 50pk/bx","code_information":[{"code":"2580534","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580534","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Micro Mist Nebulizer Sm Volume Pipe","code_information":[{"code":"2580626","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580626","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Catheter Suction 10fr W-tip","code_information":[{"code":"2584003","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Tegaderm Dressing 4x4.75","code_information":[{"code":"2584009","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Steri-strip Closure 1/8 Inch X 3 Inch","code_information":[{"code":"2584011","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Proadvtage Telfa Pad 2x3 100/bx","code_information":[{"code":"2585015","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2585015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Xeroform Dressing 5x9-peelable 50/bx","code_information":[{"code":"2586271","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586271","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Steri-strip Closure 1/4 Inch X 1 5 Inch","code_information":[{"code":"2586765","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586765","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Replicare 4 Inch X 4 Inch Hydrocolloid","code_information":[{"code":"2586807","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586807","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Telfa Pad 2 Inch X 3 Inch Sterile","code_information":[{"code":"2586808","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586808","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Webril 3  Cast Padding 4 Yds Replaces Cm","code_information":[{"code":"2589708","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589708","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Xmid Secondary Tubing Cnvpp","code_information":[{"code":"2589719","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2589719","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nitro Tubing Prim Plumset Pe Lined 50/cs","code_information":[{"code":"2589720","type":"CDM"},{"code":"259","type":"RC"},{"code":"CP2589720","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Foley Cath 10 Fr","code_information":[{"code":"2589743","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589743","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Eze-band 4  Lf S-close Bandage","code_information":[{"code":"2589768","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589768","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Algidex Packing Strip 1/4  12/cs","code_information":[{"code":"2589773","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589773","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Tegaderm Film Roll 6  X 11yds 4/cs","code_information":[{"code":"2589792","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589792","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Tegaderm Advanced Securement 100/bx","code_information":[{"code":"2589796","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589796","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Alum 4 Prong Finger Splint Large No Foam","code_information":[{"code":"2589853","type":"CDM"},{"code":"274","type":"RC"},{"code":"CP2589853","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Eze-bandage 6  Lf S-closure 10/pk","code_information":[{"code":"2589876","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589876","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Piggyback Secondary Set Secure Lock W/ H","code_information":[{"code":"2589883","type":"CDM"},{"code":"264","type":"RC"},{"code":"CP2589883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Kerlix Roll 4.5  Sterile","code_information":[{"code":"2589887","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589887","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Dermabond Hxd Mini#12 12/bx","code_information":[{"code":"2589898","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589898","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suction Cath 10fr Coil Pack","code_information":[{"code":"2589993","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suction Cath Tray 14fr W/ Tip 100/cs","code_information":[{"code":"2589994","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Amlodipine Tab [5 Mg]","code_information":[{"code":"3000024","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Atorvastatin Tab [10 Mg]","code_information":[{"code":"3000037","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598009890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bacitracin/polymixin Oint Ud","code_information":[{"code":"3000042","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bentyl 20mg","code_information":[{"code":"3000045","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452031120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Calcium Tab [600 Mg + D 400]","code_information":[{"code":"3000055","type":"CDM"},{"code":"250","type":"RC"},{"code":"90432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Carvedilol Tab [12.5 Mg]","code_information":[{"code":"3000059","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382009401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Colchicine 0.6 Mg","code_information":[{"code":"3000126","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Coreg 3.125mg","code_information":[{"code":"3000127","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382009201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3125,"type":"ME"}},{"description":"Diazepam Tab [5 Mg]","code_information":[{"code":"3000140","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Docusate Sodium Tab 100mg","code_information":[{"code":"3000149","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739047810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Esomeprazole Cap [40 Mg]","code_information":[{"code":"3000165","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598051030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine Tab [20 Mg]","code_information":[{"code":"3000167","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877084201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fenofibrate (Tricor) 160mg Tab","code_information":[{"code":"3000168","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756021590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Fluconazole Tab [100 Mg]","code_information":[{"code":"3000177","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gabapentin Cap [100 Mg]","code_information":[{"code":"3000186","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Guaifenesin Er Tab [600 Mg]","code_information":[{"code":"3000195","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802049878","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Loratadine Tab [10 Mg]","code_information":[{"code":"3000248","type":"CDM"},{"code":"250","type":"RC"},{"code":"90457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lorazepam Tab [1 Mg]","code_information":[{"code":"3000250","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Meclizine Tab [25 Mg]","code_information":[{"code":"3000258","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746044201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Milk Of Magnesia Conc 30 Ml","code_information":[{"code":"3000271","type":"CDM"},{"code":"250","type":"RC"},{"code":"90407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Misoprostol 100mcg","code_information":[{"code":"3000273","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954044310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Morphine Oral Sol [20 Mg/ml]","code_information":[{"code":"3000277","type":"CDM"},{"code":"250","type":"RC"},{"code":"54051","type":"CPT","modifier":"744"}],"standard_charges":[{"setting":"outpatient","modifier_code":["744"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Mucinex Dm-guaifenesin/dextro 600/30 Mg","code_information":[{"code":"3000279","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824005632","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Ondansetron Odt Tab [4 Mg]","code_information":[{"code":"3000310","type":"CDM"},{"code":"636","type":"RC"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tramadol Tab [50 Mg]","code_information":[{"code":"3000376","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tums (Calc Carb) Tablet 750 Mg","code_information":[{"code":"3000381","type":"CDM"},{"code":"250","type":"RC"},{"code":"76673","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Xarelto 2.5mg","code_information":[{"code":"3000413","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Macrodantin Cap [100 Mg]","code_information":[{"code":"3000439","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Methadone Hydrochloride Tab [10 Mg]","code_information":[{"code":"3000441","type":"CDM"},{"code":"250","type":"RC"},{"code":"40657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nf-metoprolol Succinate Cap Er 25mg","code_information":[{"code":"3060805","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631000830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sof-rol Cast Padding 3 Inch X 4yds","code_information":[{"code":"2580632","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580632","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gauze Vaseline 1 Inch X36 Inch Foil Pk","code_information":[{"code":"2584022","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"6  Elastic Bandage(replaces 054956)10/pk","code_information":[{"code":"2586011","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gastric Lavage Tray Lg 34fr 20/cs","code_information":[{"code":"2586237","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586237","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Lap Sponge 18  X 18  5/pk 40pk/cs","code_information":[{"code":"2586510","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586510","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gauze Vaseline 3 X 18  Foil P","code_information":[{"code":"2586980","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586980","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Dale Foley Cath Holder 10/pk","code_information":[{"code":"2589734","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589734","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction Cath 8 Fr","code_information":[{"code":"2589740","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589740","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Pediatric Intabation Stylet","code_information":[{"code":"2589745","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589745","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Eze Bandage 3  L/f S Close 10/pk","code_information":[{"code":"2589874","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589874","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"18fr Coil Packed Suction Cath","code_information":[{"code":"2589909","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP2589909","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suture Eithilon Black Mono 5-0 P-3","code_information":[{"code":"2589919","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589919","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Vaseline Guaze 3x9 Foil Pack 50/bx","code_information":[{"code":"2589927","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Aspirin  Ec 81mg Tablet Delayed Release","code_information":[{"code":"3000032","type":"CDM"},{"code":"250","type":"RC"},{"code":"53610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Aspirin Chew Tab [81 Mg]","code_information":[{"code":"3000033","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739052210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Aspirin Ec  Tab [325 Mg]","code_information":[{"code":"3000034","type":"CDM"},{"code":"250","type":"RC"},{"code":"60301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Cl-depo-provera 150mg","code_information":[{"code":"3000078","type":"CDM"},{"code":"636","type":"RC"},{"code":"90746","type":"CPT","modifier":"35"}],"standard_charges":[{"setting":"outpatient","modifier_code":["35"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ferrous Sulfate 324 Mg Cap","code_information":[{"code":"3000171","type":"CDM"},{"code":"250","type":"RC"},{"code":"57406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":324,"type":"ME"}},{"description":"Granix 300 Mcg/0.5ml","code_information":[{"code":"3000193","type":"CDM"},{"code":"636","type":"RC"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Granix480 Mcg/0.8ml","code_information":[{"code":"3000194","type":"CDM"},{"code":"636","type":"RC"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Guaifenesin-diab Tussinliq [100 Mg/5 Ml]","code_information":[{"code":"3000197","type":"CDM"},{"code":"250","type":"RC"},{"code":"53608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ibuprofen Tab [200 Mg]","code_information":[{"code":"3000209","type":"CDM"},{"code":"250","type":"RC"},{"code":"90479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Inshumulin R 100u/ml","code_information":[{"code":"3000212","type":"CDM"},{"code":"250","type":"RC"},{"code":"28215","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Loperamide Cap [2 Mg]","code_information":[{"code":"3000247","type":"CDM"},{"code":"250","type":"RC"},{"code":"93031","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Mag-ox Tab [400 Mg]","code_information":[{"code":"3000256","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739035410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Povidine-iodine 10% Ointment 1 Applicati","code_information":[{"code":"3000328","type":"CDM"},{"code":"250","type":"RC"},{"code":"90411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Psyllium Powder","code_information":[{"code":"3000344","type":"CDM"},{"code":"250","type":"RC"},{"code":"53644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Senokot-s Tab","code_information":[{"code":"3000350","type":"CDM"},{"code":"250","type":"RC"},{"code":"90456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sucrets Sore Throat Lozenge","code_information":[{"code":"3000364","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736056718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thera M Plus Vitamin","code_information":[{"code":"3000372","type":"CDM"},{"code":"250","type":"RC"},{"code":"90454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nf-folic Acid Tablet 1mg","code_information":[{"code":"3061419","type":"CDM"},{"code":"250","type":"RC"},{"code":"63915012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nf-melatonin Oral Tablet 3mg","code_information":[{"code":"3061421","type":"CDM"},{"code":"250","type":"RC"},{"code":"40985021240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Nf-midodrine Tablet 10mg","code_information":[{"code":"3061426","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Depo Provera 1 Mg","code_information":[{"code":"8071050","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Depo Provera Dhhs","code_information":[{"code":"8073490","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS","modifier":"TH"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TH"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Hotline 3 Fluid Warming Set Level 1","code_information":[{"code":"2500047","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2500047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Webril Cast Padding 2  4yds 24/pk 3pk/cs","code_information":[{"code":"2580115","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580115","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Scotchcast Plus 3  Red 5 Yds","code_information":[{"code":"2580117","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580117","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tube Bandage Size 1 25 Yds","code_information":[{"code":"2580131","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Surgitube Size 7 25yds (Replace Gl708)","code_information":[{"code":"2580508","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580508","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Surgitube Size 5 50yds (Replace Gl-705)","code_information":[{"code":"2580509","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580509","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tube Guaze Size 1 (Replaces 703)","code_information":[{"code":"2580511","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580511","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tegaderm Film Dressing 6 X8  10/bx 8bx/c","code_information":[{"code":"2580512","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580512","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Packing Strip Plain 25  12/cs","code_information":[{"code":"2580536","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2580536","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Scotchcast White 2  4yds/rl 10/bx","code_information":[{"code":"2580542","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580542","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Scotchcast 2  Red 4yds/rl 10rl/cs","code_information":[{"code":"2580543","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580543","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Stockingette 2  25yds/bx","code_information":[{"code":"2580620","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2580620","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tegaderm 2 3/8 Inch X 2 3/4 Inch","code_information":[{"code":"2584008","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gauze Vaseline 1x8 Str","code_information":[{"code":"2584023","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Stockinette 4 Inch X 25 Yards","code_information":[{"code":"2584026","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Delta-lite+ Cast Tape 3 Inch Red","code_information":[{"code":"2584027","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Delta-lite+ Cast Tape 4 Inch Red","code_information":[{"code":"2584028","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Kerlix Super Sponge 40/tray 12tr/cs","code_information":[{"code":"2584053","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Telfa Pad 2 X 3  Adhesive St 100/box 24b","code_information":[{"code":"2584054","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2584054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Foot Printers Disposible 25/pk 4/bx","code_information":[{"code":"2584055","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2584055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tegaderm Iv Port Dressing","code_information":[{"code":"2586008","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Delta-lite+ Cast Tape 2 Inch Red","code_information":[{"code":"2586229","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586229","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Eye Pad Oval 50/box 12box/cs","code_information":[{"code":"2586340","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586340","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gauze Sponge 4x4 12ply St 2/pk 25pk/bx","code_information":[{"code":"2586394","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586394","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Conform 1 Inch Sterile","code_information":[{"code":"2586485","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Conform 2 Inch Sterile 12/bx","code_information":[{"code":"2586490","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586490","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Conform 3 Inch Sterile","code_information":[{"code":"2586495","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Conform 4 Inch Sterile","code_information":[{"code":"2586500","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586500","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Conform 6 Inch Sterile","code_information":[{"code":"2586501","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586501","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Stockinette 3 Inch X 25 Yards","code_information":[{"code":"2586785","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2586785","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Gauze Sponge 2x2 8ply Str 2's","code_information":[{"code":"2586811","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586811","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Abd Pad 5x9 Tendersorb Str 36/tray 12tr/","code_information":[{"code":"2586815","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586815","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Telfa Pad 3 Inch X 4 Inch Sterile 50/bx","code_information":[{"code":"2586850","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586850","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Telfa Pad 8 Inch X 3 Inch Sterile","code_information":[{"code":"2586852","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2586852","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Adaptic Dressing 3  X 3","code_information":[{"code":"2587003","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2587003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Scotchcast White 4  4yds/rl 10rl/cs","code_information":[{"code":"2587040","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2587040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Mucus Trap 50/cs","code_information":[{"code":"2589723","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589723","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Steri-strip 1/4  X 4  10/pk","code_information":[{"code":"2589733","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589733","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"2  Stockinette 25yds Roll","code_information":[{"code":"2589772","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589772","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Eze Bandage 2  L/f S Close 10/pk","code_information":[{"code":"2589875","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589875","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tube Gauze(stockinette Type 1 5/8 X25 Yr","code_information":[{"code":"2589877","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589877","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Adaptic Dressing 3 X8  3/pk 36/bx 6/cs","code_information":[{"code":"2589912","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP2589912","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction Canisters 1200cc Bemis","code_information":[{"code":"2589918","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589918","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tube Guaze 3 1 5","code_information":[{"code":"2589932","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP2589932","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cl-dexamethasone 10mg/ml","code_information":[{"code":"3000080","type":"CDM"},{"code":"636","type":"RC"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cl Decadron 1mg","code_information":[{"code":"8071100","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nf-cardizem La Oral Tab Er 180mg","code_information":[{"code":"3060758","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Nm Dobutamine Myocardial Perfusion Imagi","code_information":[{"code":"5760003","type":"CDM"},{"code":"341","type":"RC"},{"code":"CP5760003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield of Nebraska","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1}]}]}],"last_updated_on":"2026-03-10","location_name":["Franklin County Memorial Hospital"],"hospital_address":["1406 Q Street, Franklin, NE 68939"],"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":"Theresa Rizzo"},"type_2_npi":["1255334660"],"license_information":{"license_number":"290001","state":"NE"},"version":"3.0.0"}