{"hospital_name":"Chase County Hospital","standard_charge_information":[{"description":"Tri Ts Femur Right","code_information":[{"code":"1601800","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601800","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5467,"maximum":14838,"gross_charge":15619,"discounted_cash":15619,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14526},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14838},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5467},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8903}]}]},{"description":"Rest Mod Conical Distal Stem","code_information":[{"code":"1601818","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601818","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5300,"maximum":14385,"gross_charge":15142,"discounted_cash":15142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14082},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14385},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8631}]}]},{"description":"Reunion Tsa Modular Humeral Stem","code_information":[{"code":"1601743","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601743","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5300,"maximum":14385,"gross_charge":15142,"discounted_cash":15142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14082},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14385},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5300},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8631}]}]},{"description":"Confirm Rx Icm (Impant Cardiac Monitor)","code_information":[{"code":"1601929","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601929","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5096,"maximum":13832,"gross_charge":14560,"discounted_cash":14560,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13541},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13832},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5096},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8299}]}]},{"description":"Obinutuzumab 25 Mg/ml40 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376526652","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4930,"maximum":13381,"gross_charge":14085,"discounted_cash":14085,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13099},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13381},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4930},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8028}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Assert-iq Icm El  (Implant Cardiac Monitor)","code_information":[{"code":"1602078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4900,"maximum":13300,"gross_charge":14000,"discounted_cash":14000,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13020},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13300},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4900},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7980}]}]},{"description":"Tysabri(natalizumab) 300mg/15ml [Chas]","code_information":[{"code":"CP17640152376551914","type":"CDM"},{"code":"250","type":"RC"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4855,"maximum":13177,"gross_charge":13870,"discounted_cash":13870,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12899},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4855},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7906}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Restrata-12.5cm X 17.5cm","code_information":[{"code":"1601996","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4717,"maximum":12802,"gross_charge":13476,"discounted_cash":13476,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12533},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12802},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7681}]}]},{"description":"Tenecteplase 25 Mg (Tnkase) Rec [Chas]","code_information":[{"code":"CP17640152376557667","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242001403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4539,"maximum":12321,"gross_charge":12969,"discounted_cash":12969,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12061},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4539},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7392}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nivolumab 10 Mg/ml24 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376524450","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4370,"maximum":11863,"gross_charge":12487,"discounted_cash":12487,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11613},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11863},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4370},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7118}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tenecteplase (Tnk) 50 Mg Rec [Chas]","code_information":[{"code":"CP17640152376558526","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4283,"maximum":11624,"gross_charge":12236,"discounted_cash":12236,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11379},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11624},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6975}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"23410-repair Rotator Cuff Acute-surg Tech","code_information":[{"code":"12523410","type":"CDM"},{"code":"360","type":"RC"},{"code":"23410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4219,"maximum":11451,"gross_charge":12054,"discounted_cash":12054,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11210},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11451},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4219},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6871}]}]},{"description":"Eflapegrastim Xnst 13.2 Mg/0.6 Ml Syrn [Chas]","code_information":[{"code":"CP17640152376476589","type":"CDM"},{"code":"250","type":"RC"},{"code":"76961010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4104,"maximum":11139,"gross_charge":11725,"discounted_cash":11725,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10904},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4104},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6683}]}],"drug_information":{"unit":132,"type":"ME"}},{"description":"50590 Lithotripsy Esl","code_information":[{"code":"12550590","type":"CDM"},{"code":"790","type":"RC"},{"code":"50590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4068,"maximum":11043,"gross_charge":11624,"discounted_cash":11624,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10810},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4068},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6626}]}]},{"description":"Rest Mod Prox Cone Body","code_information":[{"code":"1601817","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601817","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3725,"maximum":10110,"gross_charge":10642,"discounted_cash":10642,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9897},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6066}]}]},{"description":"Neulasta Onpro Kit 6mg/0.6ml [Chas]","code_information":[{"code":"CP17640152376524168","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3513,"maximum":9534,"gross_charge":10036,"discounted_cash":10036,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9333},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9534},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3513},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5721}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Ado-trastuzumab Emtansine 160 Mg Rec [Chas]","code_information":[{"code":"CP17640152376430764","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3469,"maximum":9415,"gross_charge":9911,"discounted_cash":9911,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9217},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9415},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5649}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Pegfilgrastim 6 Mg/0.6 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376535038","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3411,"maximum":9259,"gross_charge":9746,"discounted_cash":9746,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9064},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9259},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3411},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5555}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"12547562","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3377,"maximum":9167,"gross_charge":9649,"discounted_cash":9649,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8974},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9167},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5500}]}]},{"description":"Pembrolizumab 25 Mg/ml4 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376531430","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3319,"maximum":9010,"gross_charge":9484,"discounted_cash":9484,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8820},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9010},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3319},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5406}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Triathlon Cr Fem Component-beaded W/pa","code_information":[{"code":"1601964","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601964","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2924,"maximum":7937,"gross_charge":8355,"discounted_cash":8355,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7770},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7937},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2924},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4762}]}]},{"description":"Reunion Tsa Cemented Humeral Stem","code_information":[{"code":"1601918","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601918","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2860,"maximum":7763,"gross_charge":8172,"discounted_cash":8172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7600},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7763},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2860},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4658}]}]},{"description":"64561 Implant Neuroelectrodesop Tech","code_information":[{"code":"14064561","type":"CDM"},{"code":"761","type":"RC"},{"code":"64561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2831,"maximum":7684,"gross_charge":8088,"discounted_cash":8088,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7522},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7684},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2831},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4610}]}]},{"description":"Immune Globulin 10%30 Gm / 300 Ml [Chas]","code_information":[{"code":"CP17640152376494957","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2785,"maximum":7560,"gross_charge":7958,"discounted_cash":7958,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7401},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7560},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2785},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4536}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Mra Lower Ext W/ + W/o Contrast","code_information":[{"code":"37573725B","type":"CDM"},{"code":"616","type":"RC"},{"code":"73725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2728,"maximum":7404,"gross_charge":7794,"discounted_cash":7794,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7248},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7404},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2728},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4443}]}]},{"description":"Secur-fit Max 132 Hip Stem #9","code_information":[{"code":"1601680","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601680","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2708,"maximum":7351,"gross_charge":7738,"discounted_cash":7738,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7351},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2708},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4411}]}]},{"description":"Leuprolide 11.25 Mg/3 Months Kit [Chas]","code_information":[{"code":"CP17640152376490629","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074366303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2685,"maximum":7287,"gross_charge":7671,"discounted_cash":7671,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7287},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2685},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4372}]}],"drug_information":{"unit":1125,"type":"ME"}},{"description":"27726 Repair Fibula Nonunioned Tech","code_information":[{"code":"12527726","type":"CDM"},{"code":"450","type":"RC"},{"code":"27726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2682,"maximum":7280,"gross_charge":7663,"discounted_cash":7663,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7280},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2682},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4368}]}]},{"description":"Restrata-10cm  X 12.5cm","code_information":[{"code":"1602009","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2640,"maximum":7167,"gross_charge":7544,"discounted_cash":7544,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7016},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7167},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2640},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4300}]}]},{"description":"Ct Abdomen/pelvis W/wo Contrastcap Panel","code_information":[{"code":"36574178","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2626,"maximum":7127,"gross_charge":7502,"discounted_cash":7502,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6977},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7127},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2626},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4276}]}]},{"description":"Rituximab 10mg/ml50 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376549064","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2574,"maximum":6985,"gross_charge":7353,"discounted_cash":7353,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6838},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6985},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2574},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4191}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ct Angiography Abdomen/pelvis W/ + W/o C","code_information":[{"code":"36574174","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2560,"maximum":6947,"gross_charge":7313,"discounted_cash":7313,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6801},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6947},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4168}]}]},{"description":"52287-cysto W/ Botox-tech","code_information":[{"code":"12552287","type":"CDM"},{"code":"360","type":"RC"},{"code":"52287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2501,"maximum":6788,"gross_charge":7145,"discounted_cash":7145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6645},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6788},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2501},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4073}]}]},{"description":"Mri Spine Cervical W/ + W/o Contrast","code_information":[{"code":"37572156","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2399,"maximum":6512,"gross_charge":6855,"discounted_cash":6855,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6375},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3907}]}]},{"description":"Mri Spine Lumbar W/ + W/o Contrast","code_information":[{"code":"37572158","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2399,"maximum":6512,"gross_charge":6855,"discounted_cash":6855,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6375},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3907}]}]},{"description":"Mri Spine Thoracic W/ + W/o Contrast","code_information":[{"code":"37572157","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2399,"maximum":6512,"gross_charge":6855,"discounted_cash":6855,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6375},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3907}]}]},{"description":"Puraply Am Xt Ef (4.91 X 4.91) 25 Sq Cm","code_information":[{"code":"1602022","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2398,"maximum":6509,"gross_charge":6852,"discounted_cash":6852,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6372},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6509},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2398},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3906}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lithotripsy Kidney W/o Charge","code_information":[{"code":"125000","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2391,"maximum":6489,"gross_charge":6831,"discounted_cash":6831,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6353},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6489},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2391},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3894}]}]},{"description":"Leuprolide 22.5 Mg/3 Months Pwd[chas]","code_information":[{"code":"CP17640152376493434","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074334603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2388,"maximum":6481,"gross_charge":6822,"discounted_cash":6822,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6344},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6481},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2388},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3889}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Durvalumab 50 Mg/ml10 Ml Sol [Chas]","code_information":[{"code":"CP17640152376475679","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2380,"maximum":6460,"gross_charge":6800,"discounted_cash":6800,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6324},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6460},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2380},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3876}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Amnioband Membrane 24 Sq Cm","code_information":[{"code":"1602072","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2373,"maximum":6441,"gross_charge":6780,"discounted_cash":6780,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6441},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2373},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3865}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"51102 Drain Bl W/cath Insertion -Ed Tech","code_information":[{"code":"13551102","type":"CDM"},{"code":"450","type":"RC"},{"code":"51102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350,"maximum":6379,"gross_charge":6715,"discounted_cash":6715,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2350},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3828}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"36574177","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2265,"maximum":6147,"gross_charge":6471,"discounted_cash":6471,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6018},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6147},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3688}]}]},{"description":"Mra Head W/ + W/o Contrast","code_information":[{"code":"37570546","type":"CDM"},{"code":"615","type":"RC"},{"code":"70546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240,"maximum":6080,"gross_charge":6400,"discounted_cash":6400,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5952},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2240},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648}]}]},{"description":"Ct Angiography Abdomen W/ + W/o Contrast","code_information":[{"code":"36574175","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2200,"maximum":5973,"gross_charge":6287,"discounted_cash":6287,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5847},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5973},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3584}]}]},{"description":"Nm Myocardial Spect Multi Rest/stress","code_information":[{"code":"37078452","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2188,"maximum":5939,"gross_charge":6252,"discounted_cash":6252,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5814},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5939},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3564}]}]},{"description":"43245egd W/ Dilation Of Gastric/duodenal","code_information":[{"code":"12543245","type":"CDM"},{"code":"750","type":"RC"},{"code":"43245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2188,"maximum":5938,"gross_charge":6251,"discounted_cash":6251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5813},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5938},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2188},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3563}]}]},{"description":"Ct Angiography Pelvis W/ + W/o Contrast","code_information":[{"code":"36572191","type":"CDM"},{"code":"352","type":"RC"},{"code":"72191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2154,"maximum":5847,"gross_charge":6155,"discounted_cash":6155,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5724},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5847},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3508}]}]},{"description":"Z1 Std Col Cmtless Sz 3","code_information":[{"code":"1602155","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602155","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2116,"maximum":5743,"gross_charge":6045,"discounted_cash":6045,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5622},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5743},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3446}]}]},{"description":"Z1 Std Col Cmtless Sz 4","code_information":[{"code":"1602149","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602149","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2116,"maximum":5743,"gross_charge":6045,"discounted_cash":6045,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5622},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5743},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3446}]}]},{"description":"Trastuzumab Anns 420 Mg Rec [Chas]","code_information":[{"code":"CP17640152376552582","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513016401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2088,"maximum":5668,"gross_charge":5966,"discounted_cash":5966,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5548},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5668},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2088},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3401}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Mri Spine Cervical W/ Contrast","code_information":[{"code":"37572142","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2086,"maximum":5663,"gross_charge":5961,"discounted_cash":5961,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5544},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5663},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2086},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3398}]}]},{"description":"Mri Spine Lumbar W/ Contrast","code_information":[{"code":"37572149","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2086,"maximum":5663,"gross_charge":5961,"discounted_cash":5961,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5544},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5663},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2086},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3398}]}]},{"description":"Mri Spine Thoracic W/ Contrast","code_information":[{"code":"37572147","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2086,"maximum":5663,"gross_charge":5961,"discounted_cash":5961,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5544},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5663},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2086},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3398}]}]},{"description":"Ossiofiber Trimmable Fixation Nail System 2.4 X 30mm","code_information":[{"code":"1601972","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601972","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2051,"maximum":5566,"gross_charge":5859,"discounted_cash":5859,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5449},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5566},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2051},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3340}]}]},{"description":"MRI Scan","code_information":[{"code":"37570553","type":"CDM"},{"code":"610","type":"RC"},{"code":"70553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2036,"maximum":5526,"gross_charge":5817,"discounted_cash":5817,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5410},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5526},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2036},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3316}]}]},{"description":"Mri Pelvis W/ + W/o Contrast","code_information":[{"code":"37572197","type":"CDM"},{"code":"619","type":"RC"},{"code":"72197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2032,"maximum":5517,"gross_charge":5807,"discounted_cash":5807,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5401},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5517},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3310}]}]},{"description":"Membrane Wrap 6x6cm (36cm Sq.)","code_information":[{"code":"1602102","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2016,"maximum":5471,"gross_charge":5759,"discounted_cash":5759,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5471},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3283}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ct Chest W/wo Contrastcap Panel","code_information":[{"code":"36571270","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2015,"maximum":5469,"gross_charge":5757,"discounted_cash":5757,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5469},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2015},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3281}]}]},{"description":"Nivolumab 10 Mg/ml10 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376523509","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1981,"maximum":5377,"gross_charge":5660,"discounted_cash":5660,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5264},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5377},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1981},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3226}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mepolizumab 100 Mg Vial [Chas]","code_information":[{"code":"CP17640152376506299","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173088101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1969,"maximum":5345,"gross_charge":5626,"discounted_cash":5626,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5232},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5345},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1969},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3207}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mra Neck W/ + W/o Contrast","code_information":[{"code":"37570549","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1963,"maximum":5329,"gross_charge":5609,"discounted_cash":5609,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5329},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1963},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3197}]}]},{"description":"Mra Head W/ Contrast","code_information":[{"code":"37570545","type":"CDM"},{"code":"615","type":"RC"},{"code":"70545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1947,"maximum":5286,"gross_charge":5564,"discounted_cash":5564,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5175},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5286},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1947},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3171}]}]},{"description":"Denosumab 120mg/1.7 Ml Sol[chas]","code_information":[{"code":"CP17640152376469451","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1941,"maximum":5268,"gross_charge":5545,"discounted_cash":5545,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5157},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5268},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1941},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3161}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Ct Abdomen/pelvis W/o Contrastcap Panel","code_information":[{"code":"36574176","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1931,"maximum":5241,"gross_charge":5517,"discounted_cash":5517,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5241},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1931},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3145}]}]},{"description":"Cruciate Retaining Femoral","code_information":[{"code":"1601657","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601657","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1908,"maximum":5179,"gross_charge":5452,"discounted_cash":5452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5070},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5179},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1908},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3108}]}]},{"description":"Mri Spine Cervical W/o Contrast","code_information":[{"code":"37572141","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1897,"maximum":5150,"gross_charge":5421,"discounted_cash":5421,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5042},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1897},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3090}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"37572148","type":"CDM"},{"code":"610","type":"RC"},{"code":"72148","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1897,"maximum":5150,"gross_charge":5421,"discounted_cash":5421,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5042},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1897},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3090}]}]},{"description":"Mri Spine Thoracic W/o Contrast","code_information":[{"code":"37572146","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1897,"maximum":5150,"gross_charge":5421,"discounted_cash":5421,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5042},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1897},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3090}]}]},{"description":"Triathlon Tritanium Baseplate","code_information":[{"code":"1601965","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601965","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1891,"maximum":5134,"gross_charge":5404,"discounted_cash":5404,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5026},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5134},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3080}]}]},{"description":"Antivenin Crotalidae Polyvlnt 1 Gm Vial[chas]","code_information":[{"code":"CP17640152376445173","type":"CDM"},{"code":"250","type":"RC"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1889,"maximum":5128,"gross_charge":5398,"discounted_cash":5398,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5020},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5128},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1889},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3077}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Plate Crossdeck","code_information":[{"code":"1601834","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1880,"maximum":5103,"gross_charge":5372,"discounted_cash":5372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4996},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1880},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3062}]}]},{"description":"Or-complex First 30 Charge","code_information":[{"code":"125002","type":"CDM"},{"code":"360","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1864,"maximum":5060,"gross_charge":5326,"discounted_cash":5326,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4953},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5060},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1864},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3036}]}]},{"description":"Ct Abdomen W/ + W/o Contrast","code_information":[{"code":"36574170","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1857,"maximum":5042,"gross_charge":5307,"discounted_cash":5307,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4936},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5042},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1857},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3025}]}]},{"description":"Nm Liver Imaging Spect","code_information":[{"code":"37078205","type":"CDM"},{"code":"341","type":"RC"},{"code":"78205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1810,"maximum":4913,"gross_charge":5172,"discounted_cash":5172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4810},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4913},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1810},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2948}]}]},{"description":"27266-treat Hip Dislocation -Ed Tech","code_information":[{"code":"13527266","type":"CDM"},{"code":"450","type":"RC"},{"code":"27266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1798,"maximum":4881,"gross_charge":5138,"discounted_cash":5138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4778},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4881},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2929}]}]},{"description":"Treat Dislocation/fracture","code_information":[{"code":"13523665","type":"CDM"},{"code":"450","type":"RC"},{"code":"23665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1798,"maximum":4881,"gross_charge":5138,"discounted_cash":5138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4778},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4881},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2929}]}]},{"description":"Ct Angiography Chest W/ Contrast","code_information":[{"code":"36571275","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1794,"maximum":4870,"gross_charge":5126,"discounted_cash":5126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4767},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4870},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1794},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2922}]}]},{"description":"Obstetric care, planned cesarean delivery","code_information":[{"code":"20059510","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":4843,"gross_charge":5098,"discounted_cash":5098,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4741},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4843},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2906}]}]},{"description":"Obstetric care, planned cesarean delivery","code_information":[{"code":"CP17640152543608799","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1784,"maximum":4843,"gross_charge":5098,"discounted_cash":5098,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4741},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4843},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1784},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2906}]}]},{"description":"Ct Angiography Aorta W/ Runoff","code_information":[{"code":"36575635","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1773,"maximum":4812,"gross_charge":5065,"discounted_cash":5065,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4710},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4812},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1773},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2887}]}]},{"description":"Mra Head W/o Contrast","code_information":[{"code":"37570544","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1771,"maximum":4807,"gross_charge":5060,"discounted_cash":5060,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4706},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4807},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1771},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2884}]}]},{"description":"Mri Brain W/ Contrast","code_information":[{"code":"37570552","type":"CDM"},{"code":"610","type":"RC"},{"code":"70552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1771,"maximum":4806,"gross_charge":5059,"discounted_cash":5059,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4705},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4806},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1771},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2884}]}]},{"description":"Mri Abdomen W/ + W/o Contrast","code_information":[{"code":"37574183","type":"CDM"},{"code":"619","type":"RC"},{"code":"74183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1769,"maximum":4801,"gross_charge":5054,"discounted_cash":5054,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4700},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4801},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1769},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2881}]}]},{"description":"Mri Pelvis W/ Contrast","code_information":[{"code":"37572196","type":"CDM"},{"code":"619","type":"RC"},{"code":"72196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1767,"maximum":4797,"gross_charge":5049,"discounted_cash":5049,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4696},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4797},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1767},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2878}]}]},{"description":"Ossiofiber Hammertoe Fixation Implant 2.9 X 19mm,angles 10 Degree","code_information":[{"code":"1601971","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601971","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1757,"maximum":4770,"gross_charge":5021,"discounted_cash":5021,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4670},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4770},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2862}]}]},{"description":"26951 Amputation Of Finger/thumb Ed Tech","code_information":[{"code":"12526951","type":"CDM"},{"code":"450","type":"RC"},{"code":"26951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1757,"maximum":4768,"gross_charge":5019,"discounted_cash":5019,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4668},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4768},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1757},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2861}]}]},{"description":"Mri Chest W/ + W/o Contrast","code_information":[{"code":"37571552","type":"CDM"},{"code":"619","type":"RC"},{"code":"71552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1744,"maximum":4733,"gross_charge":4982,"discounted_cash":4982,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4633},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4733},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1744},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2840}]}]},{"description":"Immune Globulin Iv-sq 10% Sol20 Gm / 200 Ml [Chas]","code_information":[{"code":"CP17640152376494629","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1726,"maximum":4684,"gross_charge":4931,"discounted_cash":4931,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4586},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4684},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1726},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2811}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Mri Le Joint W/ + W/o Contrast Right","code_information":[{"code":"37573723R-RT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1713,"maximum":4650,"gross_charge":4895,"discounted_cash":4895,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4552},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4650},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790}]}]},{"description":"Mri Lower Extremity Joint W/wo Contrast Left","code_information":[{"code":"37573723L-LT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1713,"maximum":4650,"gross_charge":4895,"discounted_cash":4895,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4552},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4650},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790}]}]},{"description":"Mri Ue Joint W/ + W/o Contrast Left","code_information":[{"code":"37573223LT-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1713,"maximum":4650,"gross_charge":4895,"discounted_cash":4895,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4552},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4650},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790}]}]},{"description":"Mri Ue Joint W/ + W/o Contrast Right","code_information":[{"code":"37573223RT-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1713,"maximum":4650,"gross_charge":4895,"discounted_cash":4895,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4552},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4650},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790}]}]},{"description":"Mra Neck W/ Contrast","code_information":[{"code":"37570548","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1707,"maximum":4634,"gross_charge":4878,"discounted_cash":4878,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4537},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4634},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1707},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2780}]}]},{"description":"Plate Maxforce Mtp, Std, 5-5, Right","code_information":[{"code":"1602004","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1673,"maximum":4540,"gross_charge":4779,"discounted_cash":4779,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4540},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1673},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2724}]}]},{"description":"Dantrolene 250 Mg Rec [Chas]","code_information":[{"code":"CP17640152376460157","type":"CDM"},{"code":"250","type":"RC"},{"code":"42367054032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1667,"maximum":4525,"gross_charge":4763,"discounted_cash":4763,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4430},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1667},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2715}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Solar Shoulder Bipolar Humeral Head","code_information":[{"code":"1601741","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601741","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1658,"maximum":4499,"gross_charge":4736,"discounted_cash":4736,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4404},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4499},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2700}]}]},{"description":"Tonsillectomy & Adenoidectomy]12 Y/o","code_information":[{"code":"12542821","type":"CDM"},{"code":"360","type":"RC"},{"code":"42821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1654,"maximum":4491,"gross_charge":4727,"discounted_cash":4727,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4491},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1654},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2694}]}]},{"description":"Flexigraft (Bisected Pat. Ligament)","code_information":[{"code":"1601956","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601956","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1653,"maximum":4486,"gross_charge":4722,"discounted_cash":4722,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4391},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4486},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1653},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2692}]}]},{"description":"Ct Pelvis W/o Contrast","code_information":[{"code":"36572192","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1647,"maximum":4471,"gross_charge":4706,"discounted_cash":4706,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4377},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4471},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1647},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2682}]}]},{"description":"Ct Soft Tissue Neck W/ + W/o Contrast","code_information":[{"code":"36570492","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1647,"maximum":4471,"gross_charge":4706,"discounted_cash":4706,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4377},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4471},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1647},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2682}]}]},{"description":"Mri Neck Soft Tissue W/ + W/o Contrast","code_information":[{"code":"37570543","type":"CDM"},{"code":"615","type":"RC"},{"code":"70543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1639,"maximum":4449,"gross_charge":4683,"discounted_cash":4683,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4355},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4449},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1639},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2669}]}]},{"description":"Obstetric care, planned vaginal delivery","code_information":[{"code":"20059400","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1622,"maximum":4403,"gross_charge":4635,"discounted_cash":4635,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4311},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4403},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1622},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2642}]}]},{"description":"Obstetric care, planned vaginal delivery","code_information":[{"code":"CP17640152543601293","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1622,"maximum":4403,"gross_charge":4635,"discounted_cash":4635,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4311},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4403},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1622},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2642}]}]},{"description":"Ct Abdomen W/ Contrast","code_information":[{"code":"36574160","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1615,"maximum":4383,"gross_charge":4614,"discounted_cash":4614,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4291},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4383},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2630}]}]},{"description":"Mri Brain W/o Contrast","code_information":[{"code":"37570551","type":"CDM"},{"code":"610","type":"RC"},{"code":"70551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1609,"maximum":4368,"gross_charge":4598,"discounted_cash":4598,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4276},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4368},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1609},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2621}]}]},{"description":"Mri Pelvis W/o Contrast","code_information":[{"code":"37572195","type":"CDM"},{"code":"619","type":"RC"},{"code":"72195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1607,"maximum":4362,"gross_charge":4592,"discounted_cash":4592,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2617}]}]},{"description":"Leuprolide 45 Mg/6 Months Syringe [Chas]","code_information":[{"code":"CP17640152376495820","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1602,"maximum":4349,"gross_charge":4578,"discounted_cash":4578,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4258},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1602},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2609}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Plate Small Mtp","code_information":[{"code":"1601602","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601602","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1581,"maximum":4292,"gross_charge":4518,"discounted_cash":4518,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4202},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4292},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2575}]}]},{"description":"Mra Abdomen W/ + W/o Contrast","code_information":[{"code":"37574185B","type":"CDM"},{"code":"616","type":"RC"},{"code":"74185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1570,"maximum":4261,"gross_charge":4485,"discounted_cash":4485,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4261},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1570},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2556}]}]},{"description":"Tri Ts Baseplate","code_information":[{"code":"1601801","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601801","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1567,"maximum":4253,"gross_charge":4477,"discounted_cash":4477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4164},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4253},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1567},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2552}]}]},{"description":"Ct Pelvis W/ + W/o Contrast","code_information":[{"code":"36572194","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1562,"maximum":4240,"gross_charge":4463,"discounted_cash":4463,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4240},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2544}]}]},{"description":"Mra Neck W/o Contrast","code_information":[{"code":"37570547","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1552,"maximum":4213,"gross_charge":4435,"discounted_cash":4435,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4125},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4213},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1552},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2528}]}]},{"description":"Mri Lower Extremity W + W/o Contrast Lt","code_information":[{"code":"37573720LT-LT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73720","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1548,"maximum":4203,"gross_charge":4424,"discounted_cash":4424,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2522}]}]},{"description":"Mri Lower Extremity W + W/o Contrast Rt","code_information":[{"code":"37573720RT-RT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73720","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1548,"maximum":4203,"gross_charge":4424,"discounted_cash":4424,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2522}]}]},{"description":"Micromatrix, 1000mg","code_information":[{"code":"1601934","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1541,"maximum":4183,"gross_charge":4403,"discounted_cash":4403,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4095},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4183},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1541},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2510}]}]},{"description":"Mri Abdomen W/ Contrast","code_information":[{"code":"37574182","type":"CDM"},{"code":"619","type":"RC"},{"code":"74182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1538,"maximum":4173,"gross_charge":4393,"discounted_cash":4393,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4085},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4173},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1538},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2504}]}]},{"description":"Mri Chest W/ Contrast","code_information":[{"code":"37571551","type":"CDM"},{"code":"619","type":"RC"},{"code":"71551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1516,"maximum":4115,"gross_charge":4332,"discounted_cash":4332,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4029},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1516},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2469}]}]},{"description":"15273skin Sub Grft T/arm/lg Child -Tech","code_information":[{"code":"10515273","type":"CDM"},{"code":"110","type":"RC"},{"code":"15273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1513,"maximum":4106,"gross_charge":4322,"discounted_cash":4322,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4019},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1513},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2464}]}]},{"description":"Goserlin Acetate Implant 10.8mg [Chas]","code_information":[{"code":"CP17640152376482910","type":"CDM"},{"code":"250","type":"RC"},{"code":"70720095130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1511,"maximum":4102,"gross_charge":4318,"discounted_cash":4318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4016},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1511},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2461}]}],"drug_information":{"unit":108,"type":"EA"}},{"description":"Ct Head Or Brain W/ + W/o Contrast","code_information":[{"code":"36570470","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1492,"maximum":4049,"gross_charge":4262,"discounted_cash":4262,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3964},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4049},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2429}]}]},{"description":"Mri Le Joint W/ Contrast Left","code_information":[{"code":"37573722L-LT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1490,"maximum":4043,"gross_charge":4256,"discounted_cash":4256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3958},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2426}]}]},{"description":"Mri Lower Extremity Joint W/ Contrast Right","code_information":[{"code":"37573722R-RT","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1490,"maximum":4043,"gross_charge":4256,"discounted_cash":4256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3958},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2426}]}]},{"description":"Mri Ue Joint W/ Contrast Left","code_information":[{"code":"37573222L-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1490,"maximum":4043,"gross_charge":4256,"discounted_cash":4256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3958},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2426}]}]},{"description":"Mri Ue Joint W/ Contrast Right","code_information":[{"code":"37573222R-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1490,"maximum":4043,"gross_charge":4256,"discounted_cash":4256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3958},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2426}]}]},{"description":"Ct Maxillofacial W/ + W/o Contrast","code_information":[{"code":"36570488","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1469,"maximum":3988,"gross_charge":4198,"discounted_cash":4198,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3904},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3988},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2393}]}]},{"description":"Ct Spine Thoracic W/ + W/o Contrast","code_information":[{"code":"36572130","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1469,"maximum":3988,"gross_charge":4198,"discounted_cash":4198,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3904},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3988},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1469},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2393}]}]},{"description":"Ct Abdomen W/o Contrast","code_information":[{"code":"36574150","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1468,"maximum":3984,"gross_charge":4194,"discounted_cash":4194,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3900},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3984},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1468},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2391}]}]},{"description":"Mri Bone Marrow Blood","code_information":[{"code":"37577084","type":"CDM"},{"code":"619","type":"RC"},{"code":"77084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1462,"maximum":3967,"gross_charge":4176,"discounted_cash":4176,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3884},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3967},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1462},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2380}]}]},{"description":"Mri Tmj","code_information":[{"code":"37570336","type":"CDM"},{"code":"619","type":"RC"},{"code":"70336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1462,"maximum":3967,"gross_charge":4176,"discounted_cash":4176,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3884},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3967},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1462},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2380}]}]},{"description":"Mri Upper Extremity W/ + W/o Contrast Rt","code_information":[{"code":"37573220R-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1451,"maximum":3939,"gross_charge":4146,"discounted_cash":4146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3856},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3939},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1451},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Mri Upper Extremity W/ + W/o Contrast Lt","code_information":[{"code":"37573220L-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1451,"maximum":3939,"gross_charge":4146,"discounted_cash":4146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3856},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3939},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1451},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Insertion Of Picc","code_information":[{"code":"12536569","type":"CDM"},{"code":"360","type":"RC"},{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1449,"maximum":3934,"gross_charge":4141,"discounted_cash":4141,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3851},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3934},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2360}]}]},{"description":"Mri Upper Extremity W/ Contrast Rt","code_information":[{"code":"37573219R-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1448,"maximum":3929,"gross_charge":4136,"discounted_cash":4136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3846},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1448},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2358}]}]},{"description":"Mri Upper Extremity W/ Contrast Lt","code_information":[{"code":"37573219L-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1448,"maximum":3929,"gross_charge":4136,"discounted_cash":4136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3846},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1448},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2358}]}]},{"description":"Tibial Bearing Insertcs","code_information":[{"code":"1601808","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601808","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1446,"maximum":3924,"gross_charge":4130,"discounted_cash":4130,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3841},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3924},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2354}]}]},{"description":"Tibial Bearing Insert -Ps","code_information":[{"code":"1601802","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601802","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1446,"maximum":3924,"gross_charge":4130,"discounted_cash":4130,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3841},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3924},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2354}]}]},{"description":"Anterior Midshaft Plate 7 Hole","code_information":[{"code":"1601982","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1444,"maximum":3921,"gross_charge":4127,"discounted_cash":4127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3838},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3921},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1444},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2352}]}]},{"description":"Ct Chest W/contrast","code_information":[{"code":"36571260","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1439,"maximum":3906,"gross_charge":4112,"discounted_cash":4112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3824},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3906},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1439},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2344}]}]},{"description":"Ct Soft Tissue Neck W/ Contrast","code_information":[{"code":"36570491","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1432,"maximum":3887,"gross_charge":4092,"discounted_cash":4092,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3806},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3887},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1432},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Neck Soft Tissue W/ Contrast","code_information":[{"code":"37570542","type":"CDM"},{"code":"615","type":"RC"},{"code":"70542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1425,"maximum":3868,"gross_charge":4072,"discounted_cash":4072,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3787},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3868},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2321}]}]},{"description":"Mini Ignite Bma Kit/dbm","code_information":[{"code":"1601607","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601607","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":3831,"gross_charge":4033,"discounted_cash":4033,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3751},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3831},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2299}]}]},{"description":"Or-intermediate First 30 Charge","code_information":[{"code":"125004","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1406,"maximum":3815,"gross_charge":4016,"discounted_cash":4016,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3815},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2289}]}]},{"description":"Primary Tritanium Hemi Cluster Hole Cup","code_information":[{"code":"1601904","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601904","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1406,"maximum":3815,"gross_charge":4016,"discounted_cash":4016,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3815},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2289}]}]},{"description":"Restrata-2.5cm X 7.5cm","code_information":[{"code":"1601943","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1406,"maximum":3815,"gross_charge":4016,"discounted_cash":4016,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3815},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1406},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2289}]}]},{"description":"Quickclip Pro","code_information":[{"code":"1601916","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601916","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1399,"maximum":3796,"gross_charge":3996,"discounted_cash":3996,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3716},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3796},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1399},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2278}]}]},{"description":"Mri Abdomen W/o Contrast","code_information":[{"code":"37574181","type":"CDM"},{"code":"619","type":"RC"},{"code":"74181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1398,"maximum":3794,"gross_charge":3994,"discounted_cash":3994,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3794},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1398},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2277}]}]},{"description":"Tibial Bearing Insert-cr","code_information":[{"code":"1601659","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601659","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1390,"maximum":3772,"gross_charge":3971,"discounted_cash":3971,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3693},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1390},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2263}]}]},{"description":"Mri Chest W/o Contrast","code_information":[{"code":"37571550","type":"CDM"},{"code":"619","type":"RC"},{"code":"71550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1379,"maximum":3742,"gross_charge":3939,"discounted_cash":3939,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3663},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3742},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1379},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2245}]}]},{"description":"71555 Mra Chest Without Contrast","code_information":[{"code":"37571555","type":"CDM"},{"code":"618","type":"RC"},{"code":"71555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1377,"maximum":3738,"gross_charge":3935,"discounted_cash":3935,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3660},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3738},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2243}]}]},{"description":"G7 Vit E Neutral Lnr 32mm B","code_information":[{"code":"1602153","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1377,"maximum":3737,"gross_charge":3934,"discounted_cash":3934,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3659},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2242}]}]},{"description":"G7 Vit E Neutral Lnr 32mm C","code_information":[{"code":"1602148","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602148","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1377,"maximum":3737,"gross_charge":3934,"discounted_cash":3934,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3659},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2242}]}]},{"description":"Hyprocure","code_information":[{"code":"1601627","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601627","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1377,"maximum":3737,"gross_charge":3934,"discounted_cash":3934,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3659},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2242}]}]},{"description":"Ossiofiber Cannulated Trimmable Fixation Nail System 3.0x50mm","code_information":[{"code":"1601973","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601973","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1374,"maximum":3730,"gross_charge":3926,"discounted_cash":3926,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3651},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3730},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1374},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2238}]}]},{"description":"Ct Spine Lumbar W/o Contrast","code_information":[{"code":"36572131","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1366,"maximum":3707,"gross_charge":3902,"discounted_cash":3902,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3629},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3707},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1366},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2224}]}]},{"description":"Ct Chest W/o Contrastcap Panel","code_information":[{"code":"36571250","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1360,"maximum":3692,"gross_charge":3886,"discounted_cash":3886,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3614},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3692},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2215}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"36572193","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1359,"maximum":3688,"gross_charge":3882,"discounted_cash":3882,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3688},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1359},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2213}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"37573721LT-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1354,"maximum":3676,"gross_charge":3869,"discounted_cash":3869,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1354},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2205}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"37573721RT-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1354,"maximum":3676,"gross_charge":3869,"discounted_cash":3869,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1354},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2205}]}]},{"description":"Mri Ue Joint W/o Contrast Left","code_information":[{"code":"37573221LT-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1354,"maximum":3676,"gross_charge":3869,"discounted_cash":3869,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1354},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2205}]}]},{"description":"Mri Ue Joint W/o Contrast Right","code_information":[{"code":"37573221RT-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1354,"maximum":3676,"gross_charge":3869,"discounted_cash":3869,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3598},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3676},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1354},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2205}]}]},{"description":"Screw Compression Cannulated","code_information":[{"code":"1601927","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1338,"maximum":3631,"gross_charge":3822,"discounted_cash":3822,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3554},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3631},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1338},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2179}]}]},{"description":"Wound Matrix 3-layer 7 X 10","code_information":[{"code":"1601933","type":"CDM"},{"code":"272","type":"RC"},{"code":"Q4166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1336,"maximum":3626,"gross_charge":3817,"discounted_cash":3817,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3550},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3626},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1336},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2176}]}]},{"description":"Pegfilgrastim Jmdb 6 Mg/0.6 Ml [Chas]","code_information":[{"code":"CP17640152376530039","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1322,"maximum":3587,"gross_charge":3776,"discounted_cash":3776,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3512},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3587},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1322},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2152}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Mri Upper Extremity W/o Contrast Lt","code_information":[{"code":"37573218L-LT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1316,"maximum":3573,"gross_charge":3761,"discounted_cash":3761,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3498},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3573},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2144}]}]},{"description":"Mri Upper Extremity W/o Contrast Rt","code_information":[{"code":"37573218R-RT","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1316,"maximum":3573,"gross_charge":3761,"discounted_cash":3761,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3498},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3573},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1316},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2144}]}]},{"description":"Ct Spine Cervical W/o Contrast","code_information":[{"code":"36572125","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1311,"maximum":3559,"gross_charge":3746,"discounted_cash":3746,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3484},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3559},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2135}]}]},{"description":"Ct Maxillofacial W/ Contrast","code_information":[{"code":"36570487","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1311,"maximum":3558,"gross_charge":3745,"discounted_cash":3745,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3483},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3558},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2135}]}]},{"description":"Ct Soft Tissue Neck W/o Contrast","code_information":[{"code":"36570490","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1302,"maximum":3533,"gross_charge":3719,"discounted_cash":3719,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3459},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3533},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2120}]}]},{"description":"Ct Head Or Brain W/ Contrast","code_information":[{"code":"36570460","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1298,"maximum":3523,"gross_charge":3708,"discounted_cash":3708,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3448},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3523},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2114}]}]},{"description":"Mri Neck Soft Tissue W/o Contrast","code_information":[{"code":"37570540","type":"CDM"},{"code":"615","type":"RC"},{"code":"70540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1296,"maximum":3518,"gross_charge":3703,"discounted_cash":3703,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3518},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2111}]}]},{"description":"Tri Cemented Stem","code_information":[{"code":"1601804","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601804","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1295,"maximum":3516,"gross_charge":3701,"discounted_cash":3701,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3442},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3516},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2110}]}]},{"description":"Ct Angiography Head W/ + W/o Contrast","code_information":[{"code":"36570496","type":"CDM"},{"code":"352","type":"RC"},{"code":"70496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1292,"maximum":3507,"gross_charge":3692,"discounted_cash":3692,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3434},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3507},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2104}]}]},{"description":"Omnifit Eon (Cemented Hip Stem)","code_information":[{"code":"1601761","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601761","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1292,"maximum":3507,"gross_charge":3692,"discounted_cash":3692,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3434},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3507},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1292},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2104}]}]},{"description":"Primary Tibial Baseplate","code_information":[{"code":"1601658","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601658","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1283,"maximum":3482,"gross_charge":3665,"discounted_cash":3665,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3408},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3482},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2089}]}]},{"description":"Humeral Sutureplate, 3-hole","code_information":[{"code":"1601922","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601922","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1283,"maximum":3482,"gross_charge":3665,"discounted_cash":3665,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3408},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3482},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2089}]}]},{"description":"Ct Lower Extremity W/ Contrast Left","code_information":[{"code":"36573701LT","type":"CDM"},{"code":"351","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1278,"maximum":3468,"gross_charge":3651,"discounted_cash":3651,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3395},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3468},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2081}]}]},{"description":"Ct Lower Extremity W/ Contrast Right","code_information":[{"code":"36573701RT","type":"CDM"},{"code":"351","type":"RC"},{"code":"73701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1278,"maximum":3468,"gross_charge":3651,"discounted_cash":3651,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3395},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3468},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1278},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2081}]}]},{"description":"Circumcision Charge","code_information":[{"code":"12554150","type":"CDM"},{"code":"761","type":"RC"},{"code":"54150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1277,"maximum":3466,"gross_charge":3648,"discounted_cash":3648,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3393},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3466},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2079}]}]},{"description":"Golimumab 50 Mg/4 Ml Sol [Chas]","code_information":[{"code":"CP17640152376480035","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1268,"maximum":3443,"gross_charge":3624,"discounted_cash":3624,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3370},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3443},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1268},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2066}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Reunion Tsa Single Radius Humeral Head","code_information":[{"code":"1601788","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601788","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1249,"maximum":3390,"gross_charge":3568,"discounted_cash":3568,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3318},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1249},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2034}]}]},{"description":"C-taper Biolox Delta Head 36mm/-5","code_information":[{"code":"1601681","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601681","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"Trident 10 Degreex3 Insert 36mm Id","code_information":[{"code":"1601678","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601678","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"Trident Psl Ha Cluster 50mm","code_information":[{"code":"1601677","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601677","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"Ct Angiography Neck W/wo Contrast","code_information":[{"code":"36570498","type":"CDM"},{"code":"352","type":"RC"},{"code":"70498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"Biolox Delta Univer Taper Anatonic Head","code_information":[{"code":"1601750","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601750","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"C-taper Cocr Lfit Head","code_information":[{"code":"1601751","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":3373,"gross_charge":3550,"discounted_cash":3550,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3373},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2023}]}]},{"description":"Ct Upper Extremity W/ Contrast Left","code_information":[{"code":"36573201L","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1225,"maximum":3325,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995}]}]},{"description":"Ct Upper Extremity W/ Contrast Right","code_information":[{"code":"36573201R","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1225,"maximum":3325,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995}]}]},{"description":"Carbofix Distal Volar Radius Plate 3 Holes-right","code_information":[{"code":"1602137","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602137","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1225,"maximum":3325,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995}]}]},{"description":"G7 Pps Ltd Acet Shell 46b","code_information":[{"code":"1602152","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602152","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1225,"maximum":3325,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995}]}]},{"description":"G7 Pps Ltd Acet Shell 48c","code_information":[{"code":"1602147","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1225,"maximum":3325,"gross_charge":3500,"discounted_cash":3500,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995}]}]},{"description":"Mri Le W/o Contrast Lt","code_information":[{"code":"37573718L","type":"CDM"},{"code":"614","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1224,"maximum":3323,"gross_charge":3498,"discounted_cash":3498,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3323},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1994}]}]},{"description":"Mri Le W/o Contrast Rt","code_information":[{"code":"37573718R","type":"CDM"},{"code":"614","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1224,"maximum":3323,"gross_charge":3498,"discounted_cash":3498,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3323},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1994}]}]},{"description":"Brca1 & Brca2 Panel Pspc","code_information":[{"code":"35081162P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1216,"maximum":3299,"gross_charge":3473,"discounted_cash":3473,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3299},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1980}]}]},{"description":"Ct Spine Thoracic W/o Contrast","code_information":[{"code":"36572128","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1212,"maximum":3291,"gross_charge":3464,"discounted_cash":3464,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3222},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3291},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1212},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1974}]}]},{"description":"Lesion Remove Colonoscopy","code_information":[{"code":"12545384","type":"CDM"},{"code":"750","type":"RC"},{"code":"45384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1190,"maximum":3229,"gross_charge":3399,"discounted_cash":3399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3229},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1190},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937}]}]},{"description":"Ct Iac W/ + W/o Contrast","code_information":[{"code":"36570482","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189,"maximum":3226,"gross_charge":3396,"discounted_cash":3396,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1189},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1936}]}]},{"description":"CT scan","code_information":[{"code":"36570450","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1180,"maximum":3202,"gross_charge":3371,"discounted_cash":3371,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3135},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3202},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1921}]}]},{"description":"Tri Stem Extender","code_information":[{"code":"1601805","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601805","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1176,"maximum":3191,"gross_charge":3359,"discounted_cash":3359,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3191},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1915}]}]},{"description":"Doxorubicin Liposomal 2 Mg/ml Dsp25 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376479892","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710153101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1175,"maximum":3188,"gross_charge":3356,"discounted_cash":3356,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3121},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3188},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1175},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1913}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tri Rm/ll Ti B Aug","code_information":[{"code":"1601803","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601803","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1168,"maximum":3169,"gross_charge":3336,"discounted_cash":3336,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3102},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3169},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1168},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1902}]}]},{"description":"Delivery Service","code_information":[{"code":"120000","type":"CDM"},{"code":"720","type":"RC"},{"code":"CP120000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1167,"maximum":3167,"gross_charge":3334,"discounted_cash":3334,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3167},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1167},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1900}]}]},{"description":"25520-treat Fracture Of Radiused Tech","code_information":[{"code":"12525520","type":"CDM"},{"code":"450","type":"RC"},{"code":"25520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1166,"maximum":3164,"gross_charge":3331,"discounted_cash":3331,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3098},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1166},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1899}]}]},{"description":"Ct Lower Extremity W/o Contrast Left","code_information":[{"code":"36573700LT-LT","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1162,"maximum":3153,"gross_charge":3319,"discounted_cash":3319,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3087},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"Ct Lower Extremity W/o Contrast Right","code_information":[{"code":"36573700RT-RT","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1162,"maximum":3153,"gross_charge":3319,"discounted_cash":3319,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3087},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1162},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1892}]}]},{"description":"Ct Spine Lumbar W/ + W/o Contrast","code_information":[{"code":"36572133","type":"CDM"},{"code":"350","type":"RC"},{"code":"72133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1154,"maximum":3131,"gross_charge":3296,"discounted_cash":3296,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3065},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1154},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1879}]}]},{"description":"Speedbridge Kit","code_information":[{"code":"1602008","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1153,"maximum":3129,"gross_charge":3294,"discounted_cash":3294,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3063},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1153},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1878}]}]},{"description":"Denosumab 60 Mg[chas]","code_information":[{"code":"CP17640152376466313","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1134,"maximum":3078,"gross_charge":3240,"discounted_cash":3240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3013},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3078},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1134},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1847}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"10121 Remove Fbed Tech","code_information":[{"code":"12510121","type":"CDM"},{"code":"450","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1124,"maximum":3051,"gross_charge":3212,"discounted_cash":3212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2987},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3051},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1124},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1831}]}]},{"description":"Egd With Polypectemy By Hot Biopsy Forceps","code_information":[{"code":"12543250","type":"CDM"},{"code":"750","type":"RC"},{"code":"43250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1117,"maximum":3031,"gross_charge":3190,"discounted_cash":3190,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2967},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3031},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1117},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1818}]}]},{"description":"Ct Upper Extremity W/o Contrast Left","code_information":[{"code":"36573200LT-LT","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1114,"maximum":3024,"gross_charge":3183,"discounted_cash":3183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2960},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3024},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1814}]}]},{"description":"Ct Upper Extremity W/o Contrast Right","code_information":[{"code":"36573200RT-RT","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1114,"maximum":3024,"gross_charge":3183,"discounted_cash":3183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2960},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3024},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1114},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1814}]}]},{"description":"Ct Angiography Lower Extremity Left","code_information":[{"code":"36573706L","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1108,"maximum":3009,"gross_charge":3167,"discounted_cash":3167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2945},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3009},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1805}]}]},{"description":"Ct Angiography Lower Extremity Right","code_information":[{"code":"36573706R","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1108,"maximum":3009,"gross_charge":3167,"discounted_cash":3167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2945},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3009},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1108},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1805}]}]},{"description":"Plate Iso","code_information":[{"code":"1601877","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601877","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1079,"maximum":2929,"gross_charge":3083,"discounted_cash":3083,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2867},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1757}]}]},{"description":"Suture Anchor Biocomposite Suture Tak Small Joint","code_information":[{"code":"1601988","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1079,"maximum":2929,"gross_charge":3083,"discounted_cash":3083,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2867},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1757}]}]},{"description":"Tritanium Asymmetric Metal Backed Patella","code_information":[{"code":"1601966","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601966","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1079,"maximum":2929,"gross_charge":3083,"discounted_cash":3083,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2867},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1757}]}]},{"description":"Inj Foramen Epidural C/t","code_information":[{"code":"12564479","type":"CDM"},{"code":"360","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1077,"maximum":2923,"gross_charge":3077,"discounted_cash":3077,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2862},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2923},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1077},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1754}]}]},{"description":"Remove Lesion Snare Tech","code_information":[{"code":"12543251","type":"CDM"},{"code":"750","type":"RC"},{"code":"43251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":2916,"gross_charge":3069,"discounted_cash":3069,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2854},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2916},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1074},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1749}]}]},{"description":"Esoph Egd Dilation <30 Mm- Facility","code_information":[{"code":"12543249","type":"CDM"},{"code":"750","type":"RC"},{"code":"43249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":2916,"gross_charge":3069,"discounted_cash":3069,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2854},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2916},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1074},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1749}]}]},{"description":"52310 -Cystoscopy And Treatment -Tech","code_information":[{"code":"12552310","type":"CDM"},{"code":"761","type":"RC"},{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1068,"maximum":2898,"gross_charge":3050,"discounted_cash":3050,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2837},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2898},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1738}]}]},{"description":"Us Echocardiogram Complete","code_information":[{"code":"38093306","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1067,"maximum":2896,"gross_charge":3048,"discounted_cash":3048,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2835},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2896},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1067},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1737}]}]},{"description":"Fusion Flex Allograft","code_information":[{"code":"1601608","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601608","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1061,"maximum":2879,"gross_charge":3031,"discounted_cash":3031,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2819},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2879},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1061},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1728}]}]},{"description":"Nm Hida Scan W/ Cck","code_information":[{"code":"37078227","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1055,"maximum":2862,"gross_charge":3013,"discounted_cash":3013,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2802},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2862},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1055},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1717}]}]},{"description":"Abatacept 250 Mg Rec [Chas]","code_information":[{"code":"CP17640152376423795","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003218713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1050,"maximum":2851,"gross_charge":3001,"discounted_cash":3001,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2791},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1050},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1711}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ado-trastuzumab Emtansine 100 Mg Rec [Chas]","code_information":[{"code":"CP17640152376436624","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1050,"maximum":2851,"gross_charge":3001,"discounted_cash":3001,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2791},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1050},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1711}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"36556 Insertion Of Central Line Clinic Charge","code_information":[{"code":"12536556","type":"CDM"},{"code":"761","type":"RC"},{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1049,"maximum":2848,"gross_charge":2998,"discounted_cash":2998,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2788},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2848},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1049},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1709}]}]},{"description":"45331-sigmoidoscopy & Biopsy-tech","code_information":[{"code":"12545331","type":"CDM"},{"code":"750","type":"RC"},{"code":"45331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1047,"maximum":2842,"gross_charge":2992,"discounted_cash":2992,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2783},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2842},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1047},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1705}]}]},{"description":"Romosozumab 105 Mg/1.17 Ml Sol [Chas]","code_information":[{"code":"CP17640152376545661","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1042,"maximum":2828,"gross_charge":2977,"discounted_cash":2977,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2828},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1697}]}],"drug_information":{"unit":105,"type":"ME"}},{"description":"Nm Lung Ventilation & Perfusion","code_information":[{"code":"37078582","type":"CDM"},{"code":"341","type":"RC"},{"code":"78582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1041,"maximum":2825,"gross_charge":2974,"discounted_cash":2974,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2766},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2825},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1041},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1695}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"12543235","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1039,"maximum":2820,"gross_charge":2968,"discounted_cash":2968,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2760},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2820},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1692}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"12543239","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1039,"maximum":2820,"gross_charge":2968,"discounted_cash":2968,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2760},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2820},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1692}]}]},{"description":"Implant Large Cannulated","code_information":[{"code":"1601872","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601872","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1037,"maximum":2816,"gross_charge":2964,"discounted_cash":2964,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2757},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2816},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1037},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1689}]}]},{"description":"Tritanium Symmetric Metal Backed Patella","code_information":[{"code":"1602020","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1037,"maximum":2816,"gross_charge":2964,"discounted_cash":2964,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2757},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2816},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1037},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1689}]}]},{"description":"Internal Brace Kit W/cc Ft And Jumpstart","code_information":[{"code":"1601974","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601974","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1034,"maximum":2807,"gross_charge":2955,"discounted_cash":2955,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2748},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2807},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1034},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1684}]}]},{"description":"K-less Tightrope Assembly W/inserter","code_information":[{"code":"1601987","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1034,"maximum":2807,"gross_charge":2955,"discounted_cash":2955,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2748},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2807},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1034},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1684}]}]},{"description":"Ct Iac W/ Contrast","code_information":[{"code":"36570481","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1033,"maximum":2803,"gross_charge":2951,"discounted_cash":2951,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2744},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2803},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1682}]}]},{"description":"Micromatrix, 500mg","code_information":[{"code":"1601944","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601944","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1032,"maximum":2802,"gross_charge":2949,"discounted_cash":2949,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2743},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2802},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1681}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"12545378-PT","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT","modifier":"PT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PT"],"minimum":1021,"maximum":2772,"gross_charge":2918,"discounted_cash":2918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"12545380-PT","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT","modifier":"PT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PT"],"minimum":1021,"maximum":2772,"gross_charge":2918,"discounted_cash":2918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"12545378","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1021,"maximum":2772,"gross_charge":2918,"discounted_cash":2918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"12545380","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1021,"maximum":2772,"gross_charge":2918,"discounted_cash":2918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663}]}]},{"description":"Endoscopic Evaluation Of Small Intestinal Pouch; Diagnostic, With/without Collection Of Specimen(s)","code_information":[{"code":"12544385","type":"CDM"},{"code":"750","type":"RC"},{"code":"44385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1021,"maximum":2772,"gross_charge":2918,"discounted_cash":2918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2772},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663}]}]},{"description":"Hyaluronanate Sodium 88 Mg/4 Ml Syrn [Chas]","code_information":[{"code":"CP17640152376480505","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676082001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1017,"maximum":2760,"gross_charge":2905,"discounted_cash":2905,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2702},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2760},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1656}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"49083- Abd Paracentesis W/ Imaging -Tech","code_information":[{"code":"14049083","type":"CDM"},{"code":"761","type":"RC"},{"code":"49083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1012,"maximum":2747,"gross_charge":2892,"discounted_cash":2892,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2690},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2747},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1012},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1648}]}]},{"description":"Prothrombin Complex 500 Units[chas]","code_information":[{"code":"CP17640152376541850","type":"CDM"},{"code":"250","type":"RC"},{"code":"63833038602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1008,"maximum":2737,"gross_charge":2881,"discounted_cash":2881,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2679},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2737},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1642}]}],"drug_information":{"unit":500,"type":"UN"}},{"description":"Omega, 4.75mm Peek Knotless Anchor System, Dbl-dbl","code_information":[{"code":"1602070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":997,"maximum":2708,"gross_charge":2850,"discounted_cash":2850,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2651},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2708},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1624}]}]},{"description":"27810 Closed Treatment Of Bimalleolar Ankle Fracture, W/ Manipulation, Ed Fee","code_information":[{"code":"13527810","type":"CDM"},{"code":"450","type":"RC"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":996,"maximum":2705,"gross_charge":2847,"discounted_cash":2847,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2648},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2705},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":996},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1623}]}]},{"description":"23605 Cltx Prox Humrl Fx W/manj W/wo Skeletal Tracj Techfee","code_information":[{"code":"13523605","type":"CDM"},{"code":"450","type":"RC"},{"code":"23605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":995,"maximum":2702,"gross_charge":2844,"discounted_cash":2844,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2645},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2702},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":995},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1621}]}]},{"description":"27818 Cltx Trimalleolar Ankle Fx W/manipulation Techfee","code_information":[{"code":"13527818","type":"CDM"},{"code":"450","type":"RC"},{"code":"27818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":988,"maximum":2683,"gross_charge":2824,"discounted_cash":2824,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2626},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2683},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":988},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1610}]}]},{"description":"Leuprolide 22.5 Mg/3 Months [Chas]","code_information":[{"code":"CP17640152376491059","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":980,"maximum":2661,"gross_charge":2801,"discounted_cash":2801,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2605},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2661},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1597}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Mitomycin 40 Mg Rec  [Chas]","code_information":[{"code":"CP17640152376514766","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219056800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":980,"maximum":2661,"gross_charge":2801,"discounted_cash":2801,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2605},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2661},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1597}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nivolumab 10 Mg/ml4 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376521567","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":980,"maximum":2661,"gross_charge":2801,"discounted_cash":2801,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2605},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2661},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1597}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nm Bone Imaging Whole Body","code_information":[{"code":"37078306","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":974,"maximum":2643,"gross_charge":2782,"discounted_cash":2782,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2587},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2643},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1586}]}]},{"description":"Stimulan Paste Kit Rapid Cure 10cc","code_information":[{"code":"1601779","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601779","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":971,"maximum":2636,"gross_charge":2775,"discounted_cash":2775,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2581},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":971},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1582}]}]},{"description":"Uhr Universal Head Bipolar Component","code_information":[{"code":"1601764","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601764","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":971,"maximum":2636,"gross_charge":2775,"discounted_cash":2775,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2581},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":971},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1582}]}]},{"description":"25565 Closed Tx Radial&ulnar Shaft Fractures W/manj Techfee","code_information":[{"code":"13525565","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":962,"maximum":2611,"gross_charge":2748,"discounted_cash":2748,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2556},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2611},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":962},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1566}]}]},{"description":"Or-simple First 30 Min Charge","code_information":[{"code":"125007","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":947,"maximum":2571,"gross_charge":2706,"discounted_cash":2706,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2517},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2571},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1542}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"12545385","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":947,"maximum":2570,"gross_charge":2705,"discounted_cash":2705,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2516},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2570},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1542}]}]},{"description":"Ct Iac W/o Contrast","code_information":[{"code":"36570480","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":940,"maximum":2551,"gross_charge":2685,"discounted_cash":2685,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2497},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2551},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":940},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1530}]}]},{"description":"Solar Shoulder Bipolar Modular Head","code_information":[{"code":"1601740","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601740","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":935,"maximum":2538,"gross_charge":2672,"discounted_cash":2672,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2485},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2538},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":935},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1523}]}]},{"description":"Hyaluronate Sod 48 Mg/6 Ml Syringe[chas]","code_information":[{"code":"CP17640152376481101","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":929,"maximum":2522,"gross_charge":2655,"discounted_cash":2655,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2469},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2522},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":929},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1513}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Asymmetric Patella","code_information":[{"code":"1601709","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":922,"maximum":2502,"gross_charge":2634,"discounted_cash":2634,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2450},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":922},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1501}]}]},{"description":"Operative Upper Gi Charge","code_information":[{"code":"12543247","type":"CDM"},{"code":"750","type":"RC"},{"code":"43247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":2499,"gross_charge":2631,"discounted_cash":2631,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2447},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2499},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1500}]}]},{"description":"Ct Maxillofacial W/o Contrast","code_information":[{"code":"36570486","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":917,"maximum":2489,"gross_charge":2620,"discounted_cash":2620,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2489},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":917},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1493}]}]},{"description":"Nm Bone Three Phase Study","code_information":[{"code":"37078315","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":914,"maximum":2481,"gross_charge":2612,"discounted_cash":2612,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2429},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2481},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1489}]}]},{"description":"43255-egd Control Bleeding Polyp-surg Tech","code_information":[{"code":"12543255","type":"CDM"},{"code":"750","type":"RC"},{"code":"43255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905,"maximum":2458,"gross_charge":2587,"discounted_cash":2587,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2406},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2458},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1475}]}]},{"description":"24605 Dislocation Elbow W/anes Techfee","code_information":[{"code":"13524605","type":"CDM"},{"code":"450","type":"RC"},{"code":"24605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":899,"maximum":2441,"gross_charge":2569,"discounted_cash":2569,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2389},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2441},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":899},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1464}]}]},{"description":"23655 Treat Shoulder Dislocation W/anesed Tech","code_information":[{"code":"12523655","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":898,"maximum":2439,"gross_charge":2567,"discounted_cash":2567,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2387},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2439},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":898},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1463}]}]},{"description":"25505-treat Fracture Of Radius-er Tech","code_information":[{"code":"13525505","type":"CDM"},{"code":"450","type":"RC"},{"code":"25505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":897,"maximum":2436,"gross_charge":2564,"discounted_cash":2564,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2385},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1461}]}]},{"description":"Mesh Composite 15x20cm","code_information":[{"code":"1601503","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":897,"maximum":2435,"gross_charge":2563,"discounted_cash":2563,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1461}]}]},{"description":"Apligraf 44 Sq Cm","code_information":[{"code":"1602030","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":896,"maximum":2431,"gross_charge":2559,"discounted_cash":2559,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2431},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1459}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Colorectal Screen; Hi Risk Ind","code_information":[{"code":"125G0105","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":893,"maximum":2424,"gross_charge":2552,"discounted_cash":2552,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2373},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2424},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1455}]}]},{"description":"Nm Cardiac Blood Pool Gated Single","code_information":[{"code":"37078472","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":890,"maximum":2416,"gross_charge":2543,"discounted_cash":2543,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2365},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2416},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1450}]}]},{"description":"Ferric Carboxymaltose (Elemental Iron) 50 Mg/ml15 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376474973","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":881,"maximum":2390,"gross_charge":2516,"discounted_cash":2516,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2340},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1434}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nm Bowel Image (Meckel`s)","code_information":[{"code":"37078290","type":"CDM"},{"code":"341","type":"RC"},{"code":"78290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":879,"maximum":2385,"gross_charge":2511,"discounted_cash":2511,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2335},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2385},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1431}]}]},{"description":"21315- Closed Tx Nose Fx W/o Stablj -Er Tech","code_information":[{"code":"13521315","type":"CDM"},{"code":"450","type":"RC"},{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":873,"maximum":2369,"gross_charge":2494,"discounted_cash":2494,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2319},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2369},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1422}]}]},{"description":"21320 Closed Tx Nose Fx W/stabljed Tech","code_information":[{"code":"12521320","type":"CDM"},{"code":"450","type":"RC"},{"code":"21320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":873,"maximum":2369,"gross_charge":2494,"discounted_cash":2494,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2319},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2369},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1422}]}]},{"description":"10121remove Foreign Bodyed Tech","code_information":[{"code":"13510121","type":"CDM"},{"code":"450","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":872,"maximum":2366,"gross_charge":2490,"discounted_cash":2490,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2316},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1419}]}]},{"description":"Cystourethroscopy Charge","code_information":[{"code":"12552000","type":"CDM"},{"code":"360","type":"RC"},{"code":"52000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":868,"maximum":2355,"gross_charge":2479,"discounted_cash":2479,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2355},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":868},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1413}]}]},{"description":"Synvisc Or Synvisc-one","code_information":[{"code":"200J7325","type":"CDM"},{"code":"521","type":"RC"},{"code":"J7325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":863,"maximum":2342,"gross_charge":2465,"discounted_cash":2465,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2292},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2342},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":863},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1405}]}]},{"description":"Symmetric Patella","code_information":[{"code":"1601660","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601660","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":862,"maximum":2339,"gross_charge":2462,"discounted_cash":2462,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2290},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1403}]}]},{"description":"Circumcision Neonate Charge","code_information":[{"code":"12554160","type":"CDM"},{"code":"761","type":"RC"},{"code":"54160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":846,"maximum":2296,"gross_charge":2417,"discounted_cash":2417,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2248},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2296},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1378}]}]},{"description":"Epidural Cervical Or Thoracic W/imaging Guidance","code_information":[{"code":"12562321","type":"CDM"},{"code":"360","type":"RC"},{"code":"62321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845,"maximum":2294,"gross_charge":2415,"discounted_cash":2415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2246},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2294},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":845},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1377}]}]},{"description":"Onabotulinumtoxina 200 Units Rec [Chas]","code_information":[{"code":"CP17640152376523204","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023392102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":844,"maximum":2291,"gross_charge":2412,"discounted_cash":2412,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2291},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1375}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Cscope Screening Charge","code_information":[{"code":"125G0121","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":840,"maximum":2280,"gross_charge":2400,"discounted_cash":2400,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2280},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1368}]}]},{"description":"36573- Insj Picc Rs&i 5 Yr+ -Tech","code_information":[{"code":"10536573","type":"CDM"},{"code":"761","type":"RC"},{"code":"36573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":838,"maximum":2273,"gross_charge":2393,"discounted_cash":2393,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2225},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2273},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1364}]}]},{"description":"Colonoscopy Thru Stoma Spxfacility","code_information":[{"code":"12544388","type":"CDM"},{"code":"750","type":"RC"},{"code":"44388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":836,"maximum":2269,"gross_charge":2388,"discounted_cash":2388,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2269},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1361}]}]},{"description":"11642 Excision, Malignant Lesion Face, Ears, Eyelids, Nose, Lips; 1.1-2.0 Cm Technical Charge","code_information":[{"code":"12511642","type":"CDM"},{"code":"360","type":"RC"},{"code":"11642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":829,"maximum":2251,"gross_charge":2369,"discounted_cash":2369,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2203},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2251},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":829},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1350}]}]},{"description":"64451 Injection Anesthetic Sacroiliac Joint","code_information":[{"code":"12564451","type":"CDM"},{"code":"360","type":"RC"},{"code":"64451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":829,"maximum":2250,"gross_charge":2368,"discounted_cash":2368,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2202},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":829},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1350}]}]},{"description":"99291 Emergent Care Level Crit Care Manual -Tech","code_information":[{"code":"13599291","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":823,"maximum":2233,"gross_charge":2350,"discounted_cash":2350,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2186},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":823},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1339}]}]},{"description":"49020-drainage Abdom Abscess Open Tech","code_information":[{"code":"10549020","type":"CDM"},{"code":"510","type":"RC"},{"code":"49020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":823,"maximum":2233,"gross_charge":2350,"discounted_cash":2350,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2186},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":823},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1339}]}]},{"description":"Durvalumab 50 Mg/ml2.4 Ml Sol [Chas]","code_information":[{"code":"CP17640152376475750","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310450012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":814,"maximum":2211,"gross_charge":2327,"discounted_cash":2327,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2164},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2211},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":814},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Colonoscopy W/ Ablation-tech","code_information":[{"code":"12545388","type":"CDM"},{"code":"750","type":"RC"},{"code":"45388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805,"maximum":2186,"gross_charge":2301,"discounted_cash":2301,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":805},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1312}]}]},{"description":"Nm Gi Bleed Scan","code_information":[{"code":"37078278","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796,"maximum":2161,"gross_charge":2275,"discounted_cash":2275,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2116},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2161},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1297}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"12562323","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":793,"maximum":2153,"gross_charge":2266,"discounted_cash":2266,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2107},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1292}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"CP17640152543601953","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":793,"maximum":2153,"gross_charge":2266,"discounted_cash":2266,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2107},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1292}]}]},{"description":"Aris Trans-obturator Kit","code_information":[{"code":"1601491","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601491","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":792,"maximum":2150,"gross_charge":2263,"discounted_cash":2263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":792},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1290}]}]},{"description":"Dbx Bone Matrix Paste","code_information":[{"code":"CP17640151597113408","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP17640151597113408","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":789,"maximum":2142,"gross_charge":2255,"discounted_cash":2255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2097},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2142},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1285}]}]},{"description":"Cscope W/injection Charge","code_information":[{"code":"12545381","type":"CDM"},{"code":"750","type":"RC"},{"code":"45381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":788,"maximum":2138,"gross_charge":2251,"discounted_cash":2251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2093},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2138},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":788},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1283}]}]},{"description":"Room/bed: Acute Isolation","code_information":[{"code":"105002","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP105002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":786,"maximum":2135,"gross_charge":2247,"discounted_cash":2247,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1281}]}]},{"description":"Room/bed: Acute Monitored","code_information":[{"code":"105001","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP105001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":786,"maximum":2135,"gross_charge":2247,"discounted_cash":2247,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1281}]}]},{"description":"Hyaluronate Sodium/cross Linkd 30mg/3mlsyringe[chas]","code_information":[{"code":"CP17640152376484832","type":"CDM"},{"code":"250","type":"RC"},{"code":"50016095711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":782,"maximum":2121,"gross_charge":2233,"discounted_cash":2233,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2077},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1273}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nm Gastric Emptying Study","code_information":[{"code":"37078264","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":776,"maximum":2107,"gross_charge":2218,"discounted_cash":2218,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2063},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1264}]}]},{"description":"Biolox Delta Hd 12/14 32x-3.5","code_information":[{"code":"1602150","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602150","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":776,"maximum":2106,"gross_charge":2217,"discounted_cash":2217,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2062},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1264}]}]},{"description":"C-taper Lfit Interhead","code_information":[{"code":"1601763","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601763","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":755,"maximum":2050,"gross_charge":2158,"discounted_cash":2158,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2007},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2050},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1230}]}]},{"description":"V40 Corc Lfit Head","code_information":[{"code":"1601816","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601816","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":755,"maximum":2050,"gross_charge":2158,"discounted_cash":2158,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2007},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2050},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1230}]}]},{"description":"Epoetin Alfa 40,000 Units/ml Pf Sdv [Chas]","code_information":[{"code":"CP17640152376478215","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":753,"maximum":2043,"gross_charge":2151,"discounted_cash":2151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":753},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1226}]}],"drug_information":{"unit":40,"type":"UN"}},{"description":"Omalizumab 150 Mg Vial[chas]","code_information":[{"code":"CP17640152376521013","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":753,"maximum":2043,"gross_charge":2151,"discounted_cash":2151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":753},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1226}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Internalbrace Ligament Augmentaion Repair","code_information":[{"code":"1601977","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601977","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":744,"maximum":2019,"gross_charge":2125,"discounted_cash":2125,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1976},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2019},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1211}]}]},{"description":"Us Echo 2d Complete-stress","code_information":[{"code":"38093350","type":"CDM"},{"code":"483","type":"RC"},{"code":"93350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":733,"maximum":1989,"gross_charge":2094,"discounted_cash":2094,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1947},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1989},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1194}]}]},{"description":"45330 Sigmoidoscopy Dx  Pttech","code_information":[{"code":"12545330-PT","type":"CDM"},{"code":"750","type":"RC"},{"code":"45330","type":"CPT","modifier":"PT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["PT"],"minimum":729,"maximum":1979,"gross_charge":2083,"discounted_cash":2083,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1979},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1187}]}]},{"description":"Sigmoidoscopy Dx Charge","code_information":[{"code":"12545330","type":"CDM"},{"code":"750","type":"RC"},{"code":"45330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":729,"maximum":1979,"gross_charge":2083,"discounted_cash":2083,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1979},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1187}]}]},{"description":"Us Carotid Duplex Bilateral","code_information":[{"code":"38093880","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":723,"maximum":1963,"gross_charge":2066,"discounted_cash":2066,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1921},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1963},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":723},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1178}]}]},{"description":"Restrata-2.5cm X 2.5cm","code_information":[{"code":"1601942","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601942","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":722,"maximum":1959,"gross_charge":2062,"discounted_cash":2062,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1918},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1959},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1175}]}]},{"description":"G0390 Trauma Charge","code_information":[{"code":"135G0390","type":"CDM"},{"code":"684","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":721,"maximum":1957,"gross_charge":2060,"discounted_cash":2060,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1916},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1957},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1174}]}]},{"description":"J7298 Iud Mirena Charge Chas","code_information":[{"code":"200J7298","type":"CDM"},{"code":"521","type":"RC"},{"code":"J7298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":716,"maximum":1944,"gross_charge":2046,"discounted_cash":2046,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1903},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1166}]}]},{"description":"Nm Bone Joint Imaging Multi","code_information":[{"code":"37078305","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":712,"maximum":1933,"gross_charge":2035,"discounted_cash":2035,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1893},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1160}]}]},{"description":"92960-cardioversion Electric External-ccc Ed Tech","code_information":[{"code":"13592960","type":"CDM"},{"code":"450","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":712,"maximum":1931,"gross_charge":2033,"discounted_cash":2033,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1931},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1159}]}]},{"description":"Aph Plt Acda Lr Irr 1","code_information":[{"code":"350P9037","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":708,"maximum":1921,"gross_charge":2022,"discounted_cash":2022,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1880},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1921},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1153}]}]},{"description":"Wound Matrix 3-layer 5 X 5 Cm","code_information":[{"code":"1601945","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601945","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":704,"maximum":1910,"gross_charge":2011,"discounted_cash":2011,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1910},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1146}]}]},{"description":"Nm Kidney Imaging W/ Flow W/ Pharm","code_information":[{"code":"37078708","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":703,"maximum":1909,"gross_charge":2009,"discounted_cash":2009,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1868},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1909},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":703},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1145}]}]},{"description":"Nm Bone Spect","code_information":[{"code":"37078320","type":"CDM"},{"code":"341","type":"RC"},{"code":"78320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":1884,"gross_charge":1983,"discounted_cash":1983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1844},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1884},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1130}]}]},{"description":"J7296 Iud Kyleena (Levonorgestrel) 17.5 Mcg/hr [Chas]","code_information":[{"code":"200J7296","type":"CDM"},{"code":"521","type":"RC"},{"code":"J7296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":694,"maximum":1884,"gross_charge":1983,"discounted_cash":1983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1844},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1884},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1130}]}]},{"description":"J7307 Etonogestrel Implant (Implanon)","code_information":[{"code":"200J7307","type":"CDM"},{"code":"521","type":"RC"},{"code":"J7307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":693,"maximum":1880,"gross_charge":1979,"discounted_cash":1979,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1880},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1128}]}]},{"description":"Rituximab 10mg/1 Ml10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376541806","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":680,"maximum":1845,"gross_charge":1942,"discounted_cash":1942,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1806},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1107}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dup-scan Xtr Veins Complete Bilateral Study","code_information":[{"code":"38093970","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":677,"maximum":1838,"gross_charge":1935,"discounted_cash":1935,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1838},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":677},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1103}]}]},{"description":"Treat Fracture Radius/ulna-tech","code_information":[{"code":"13525605","type":"CDM"},{"code":"450","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":674,"maximum":1831,"gross_charge":1927,"discounted_cash":1927,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1792},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1831},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1098}]}]},{"description":"Hydroxocobalamin 5 G Rec[chas]","code_information":[{"code":"CP17640152376482156","type":"CDM"},{"code":"250","type":"RC"},{"code":"50633031011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":668,"maximum":1813,"gross_charge":1908,"discounted_cash":1908,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1774},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1813},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1088}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Ferumoxytol 510 Mg/17 Ml [Chas]","code_information":[{"code":"CP17640152376476695","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":655,"maximum":1778,"gross_charge":1872,"discounted_cash":1872,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1741},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1778},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1067}]}],"drug_information":{"unit":510,"type":"ME"}},{"description":"Ligasure Impact 36mm-18cm","code_information":[{"code":"1601548","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601548","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":646,"maximum":1753,"gross_charge":1845,"discounted_cash":1845,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1716},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1753},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1052}]}]},{"description":"93017 Exercise Stress Test Chargetracing [Chas]","code_information":[{"code":"34093017","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":1749,"gross_charge":1841,"discounted_cash":1841,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1712},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1749},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1049}]}]},{"description":"Flow Cytometry Ea Addl Marker, Pspc","code_information":[{"code":"35088185P","type":"CDM"},{"code":"300","type":"RC"},{"code":"88185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":639,"maximum":1734,"gross_charge":1825,"discounted_cash":1825,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1697},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1734},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1040}]}]},{"description":"Facet Joint Inj","code_information":[{"code":"12564493","type":"CDM"},{"code":"360","type":"RC"},{"code":"64493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":634,"maximum":1720,"gross_charge":1810,"discounted_cash":1810,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1683},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1720},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":634},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1032}]}]},{"description":"Inject Paravertebral Facet Joint Single Level","code_information":[{"code":"12564490","type":"CDM"},{"code":"360","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":631,"maximum":1712,"gross_charge":1802,"discounted_cash":1802,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1712},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1027}]}]},{"description":"Pack Tx- Bone Procedure","code_information":[{"code":"1601968","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601968","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":624,"maximum":1694,"gross_charge":1783,"discounted_cash":1783,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1694},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1016}]}]},{"description":"Nm Bone Joint Imaging Limited","code_information":[{"code":"37078300","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":622,"maximum":1688,"gross_charge":1777,"discounted_cash":1777,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1653},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1688},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":1013}]}]},{"description":"Room/bed: Acute","code_information":[{"code":"105000","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP105000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":614,"maximum":1667,"gross_charge":1755,"discounted_cash":1755,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1667},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Immune Globulin 10%5 Gm /  50 Ml [Chas]","code_information":[{"code":"CP17640152376496869","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":614,"maximum":1666,"gross_charge":1754,"discounted_cash":1754,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1666},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Blood Transfusion 8 Hrsobs","code_information":[{"code":"105364304","type":"CDM"},{"code":"762","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":611,"maximum":1658,"gross_charge":1745,"discounted_cash":1745,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1623},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":995}]}]},{"description":"Blood Transfusion >8 Hrs Non-ed","code_information":[{"code":"145364304","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":611,"maximum":1658,"gross_charge":1745,"discounted_cash":1745,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1623},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":995}]}]},{"description":"Antepartum Care 7 Or More Visits59426","code_information":[{"code":"20059426","type":"CDM"},{"code":"521","type":"RC"},{"code":"59426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":611,"maximum":1658,"gross_charge":1745,"discounted_cash":1745,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1623},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1658},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":995}]}]},{"description":"Nm Hida Scan W/o Cck","code_information":[{"code":"37078226","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":609,"maximum":1653,"gross_charge":1740,"discounted_cash":1740,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1618},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1653},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":992}]}]},{"description":"Blood Transfusion >8 Hrs","code_information":[{"code":"135364304","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":1627,"gross_charge":1713,"discounted_cash":1713,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1593},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1627},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":976}]}]},{"description":"Us Renal Doppler","code_information":[{"code":"38093975","type":"CDM"},{"code":"402","type":"RC"},{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600,"maximum":1627,"gross_charge":1713,"discounted_cash":1713,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1593},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1627},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":976}]}]},{"description":"49082 Paracentesised Tech","code_information":[{"code":"12549082","type":"CDM"},{"code":"450","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":597,"maximum":1622,"gross_charge":1707,"discounted_cash":1707,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1588},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1622},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":597},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":973}]}]},{"description":"23655 Clsd Tx Shoulder Dislc W/manipulation Req Anes Techfee","code_information":[{"code":"13523655","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":596,"maximum":1618,"gross_charge":1703,"discounted_cash":1703,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1584},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1618},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":971}]}]},{"description":"Air+meniscal Systemcurved Up","code_information":[{"code":"1602055","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":587,"maximum":1593,"gross_charge":1677,"discounted_cash":1677,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1560},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1593},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":956}]}]},{"description":"Suture Anchor 4.75mm, Peek, 2 Strands Of #2 Force Fiber","code_information":[{"code":"1602069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":583,"maximum":1584,"gross_charge":1667,"discounted_cash":1667,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1584},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":950}]}]},{"description":"0232tprp Inj Major Joint Under Fluoro -Surg Tech","code_information":[{"code":"1250232T","type":"CDM"},{"code":"384","type":"RC"},{"code":"0232T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":578,"maximum":1568,"gross_charge":1651,"discounted_cash":1651,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1535},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1568},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":941}]}]},{"description":"N Block Inj Brachial Plexus","code_information":[{"code":"12564415","type":"CDM"},{"code":"360","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":1565,"gross_charge":1647,"discounted_cash":1647,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1532},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1565},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":939}]}]},{"description":"Air + Meniscal System-curved Up","code_information":[{"code":"1602021","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":575,"maximum":1562,"gross_charge":1644,"discounted_cash":1644,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1529},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1562},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":937}]}]},{"description":"Paraneoplastic Auto Ab, Nif Quant Pspc","code_information":[{"code":"35086256P2","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":574,"maximum":1557,"gross_charge":1639,"discounted_cash":1639,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1524},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":574},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934}]}]},{"description":"Burn Matrix 5 X 5 Cm","code_information":[{"code":"1601969","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601969","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":567,"maximum":1539,"gross_charge":1620,"discounted_cash":1620,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1539},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":923}]}]},{"description":"27750 Fracture Tibia Shafted Tech","code_information":[{"code":"12527750","type":"CDM"},{"code":"450","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":566,"maximum":1537,"gross_charge":1618,"discounted_cash":1618,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1505},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1537},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":922}]}]},{"description":"Nm Parathyroid Study","code_information":[{"code":"37078070","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":565,"maximum":1533,"gross_charge":1614,"discounted_cash":1614,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1533},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":920}]}]},{"description":"Reliatack Device Reltack3x10","code_information":[{"code":"1601703","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601703","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":561,"maximum":1523,"gross_charge":1603,"discounted_cash":1603,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1523},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":914}]}]},{"description":"49082abd Paracentesistech","code_information":[{"code":"14049082","type":"CDM"},{"code":"761","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":560,"maximum":1519,"gross_charge":1599,"discounted_cash":1599,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1487},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1519},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":911}]}]},{"description":"Bcr/abl Quant P210 (Rps) Pspc","code_information":[{"code":"35081206P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":551,"maximum":1496,"gross_charge":1575,"discounted_cash":1575,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1465},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1496},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":898}]}]},{"description":"Membrane Wrap 2x3cm (6 Cm Sq) â 1 Cm Sq","code_information":[{"code":"1602095","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550,"maximum":1492,"gross_charge":1571,"discounted_cash":1571,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1461},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":895}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"62325- Epidural Cervical/thoracic W/ Imaging Guidance -Tech","code_information":[{"code":"12562325","type":"CDM"},{"code":"360","type":"RC"},{"code":"62325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":543,"maximum":1474,"gross_charge":1552,"discounted_cash":1552,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1443},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1474},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":885}]}]},{"description":"Blood Transfusion 6-8 Hrsobs","code_information":[{"code":"105364303","type":"CDM"},{"code":"762","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":539,"maximum":1462,"gross_charge":1539,"discounted_cash":1539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1431},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1462},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":877}]}]},{"description":"Blood Transfusion 6-8 Hrs Non-ed","code_information":[{"code":"145364303","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":539,"maximum":1462,"gross_charge":1539,"discounted_cash":1539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1431},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1462},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":877}]}]},{"description":"32551 Insertion Of Chest Tubeed Tech","code_information":[{"code":"12532551","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":538,"maximum":1461,"gross_charge":1538,"discounted_cash":1538,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1430},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1461},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":877}]}]},{"description":"43999 Unlisted Procedure, Stomach","code_information":[{"code":"14043999","type":"CDM"},{"code":"510","type":"RC"},{"code":"43999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":537,"maximum":1456,"gross_charge":1533,"discounted_cash":1533,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1456},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":874}]}]},{"description":"Protosigmoidoscopy Dx Charge","code_information":[{"code":"12545300","type":"CDM"},{"code":"750","type":"RC"},{"code":"45300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":534,"maximum":1451,"gross_charge":1527,"discounted_cash":1527,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1451},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":870}]}]},{"description":"Immune Globulin Iv-sq 10% Sol5 Gm / 50 Ml [Chas]","code_information":[{"code":"CP17640152376499524","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":530,"maximum":1438,"gross_charge":1514,"discounted_cash":1514,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1438},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":863}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Blood Transfusion 6-8 Hrs","code_information":[{"code":"135364303","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":528,"maximum":1434,"gross_charge":1509,"discounted_cash":1509,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1403},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1434},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":860}]}]},{"description":"Nm Thyroid Imaging Only","code_information":[{"code":"37078013","type":"CDM"},{"code":"341","type":"RC"},{"code":"78013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":526,"maximum":1428,"gross_charge":1503,"discounted_cash":1503,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1398},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1428},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Room/bed: Skilled Nursing","code_information":[{"code":"110003","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP110003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":525,"maximum":1426,"gross_charge":1501,"discounted_cash":1501,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":856}]}]},{"description":"Mlg Complete Wound 2x4cm 8units","code_information":[{"code":"1602086","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":523,"maximum":1419,"gross_charge":1494,"discounted_cash":1494,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1389},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1419},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":852}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Us Le Venous Duplex Left","code_information":[{"code":"38093971L-LT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":521,"maximum":1414,"gross_charge":1488,"discounted_cash":1488,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1414},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":848}]}]},{"description":"Us Le Venous Duplex Right","code_information":[{"code":"38093971R-RT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":521,"maximum":1414,"gross_charge":1488,"discounted_cash":1488,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1414},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":848}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"12564483","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":520,"maximum":1412,"gross_charge":1486,"discounted_cash":1486,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1382},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":847}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"CP17640152543603478","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":520,"maximum":1412,"gross_charge":1486,"discounted_cash":1486,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1382},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":847}]}]},{"description":"Rabies Immune Globulin 300 Intl Units/ml [Chas]","code_information":[{"code":"CP17640152376545569","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":516,"maximum":1400,"gross_charge":1474,"discounted_cash":1474,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"28190 Removal Of Foot Fbed Tech","code_information":[{"code":"13528190","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":509,"maximum":1380,"gross_charge":1453,"discounted_cash":1453,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1351},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1380},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":828}]}]},{"description":"Mlg Complete Wound 4x8cm 32 Units","code_information":[{"code":"1602087","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":504,"maximum":1369,"gross_charge":1441,"discounted_cash":1441,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1369},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":821}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Us Ue Arterial Duplex Bilateral","code_information":[{"code":"38093930","type":"CDM"},{"code":"402","type":"RC"},{"code":"93930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504,"maximum":1368,"gross_charge":1440,"discounted_cash":1440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1368},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":821}]}]},{"description":"Us Abdominal Aorta","code_information":[{"code":"38093978","type":"CDM"},{"code":"402","type":"RC"},{"code":"93978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":1366,"gross_charge":1438,"discounted_cash":1438,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1337},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":820}]}]},{"description":"99285 Emergent Care Level 5 Manual-tech","code_information":[{"code":"13599285","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":496,"maximum":1346,"gross_charge":1417,"discounted_cash":1417,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808}]}]},{"description":"92950 Cpr-tech","code_information":[{"code":"13592950","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":1332,"gross_charge":1402,"discounted_cash":1402,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1304},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1332},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":799}]}]},{"description":"Plate Lcp 10 Holes 3.5mm","code_information":[{"code":"1601921","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601921","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":490,"maximum":1329,"gross_charge":1399,"discounted_cash":1399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1301},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1329},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":797}]}]},{"description":"Xr Fluoro Guidance Needle Placement","code_information":[{"code":"36077002","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":488,"maximum":1323,"gross_charge":1393,"discounted_cash":1393,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1323},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":794}]}]},{"description":"99292-critical Care Addl 30 Min-er Tech","code_information":[{"code":"13599292","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486,"maximum":1321,"gross_charge":1390,"discounted_cash":1390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1293},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":792}]}]},{"description":"Evicel 5ml Kit (Fibrin Sealant)","code_information":[{"code":"1601583","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601583","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":1315,"gross_charge":1384,"discounted_cash":1384,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1287},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1315},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":789}]}]},{"description":"Prevena Plus System","code_information":[{"code":"1601865","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601865","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":480,"maximum":1303,"gross_charge":1372,"discounted_cash":1372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1303},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":782}]}]},{"description":"12032 Repair Intermediate S/a/t/e 2.6-7.5 Cm Techfee","code_information":[{"code":"13512032","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":472,"maximum":1283,"gross_charge":1350,"discounted_cash":1350,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":769}]}]},{"description":"Onabotulinumtoxina 100 Units Vial [Chas]","code_information":[{"code":"CP17640152376523257","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":463,"maximum":1257,"gross_charge":1323,"discounted_cash":1323,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1230},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":754}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"General Care-hospice Charge","code_information":[{"code":"105401","type":"CDM"},{"code":"656","type":"RC"},{"code":"CP105401","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":462,"maximum":1255,"gross_charge":1321,"discounted_cash":1321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1229},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":753}]}]},{"description":"Remdesivir 100 Mg Rec [Chas]","code_information":[{"code":"CP17640152376544545","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":462,"maximum":1254,"gross_charge":1320,"discounted_cash":1320,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1228},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":752}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"32554 Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; Without Imaging Guidance","code_information":[{"code":"14532554","type":"CDM"},{"code":"761","type":"RC"},{"code":"32554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":461,"maximum":1252,"gross_charge":1318,"discounted_cash":1318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1252},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751}]}]},{"description":"Docetaxel 10 Mg/ml Sol16 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376473283","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409020120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":458,"maximum":1243,"gross_charge":1308,"discounted_cash":1308,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1243},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":746}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mlg Complete Wound 4x4cm 16 Units","code_information":[{"code":"1602089","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":456,"maximum":1239,"gross_charge":1304,"discounted_cash":1304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1213},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":743}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cricothyrotomy Cath Set Melker Universal Cuffed C-tccsb-500-uni-ca","code_information":[{"code":"1602082","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602082","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":453,"maximum":1228,"gross_charge":1293,"discounted_cash":1293,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1202},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":737}]}]},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"14047562","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":1222,"gross_charge":1286,"discounted_cash":1286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":733}]}]},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"CP17640152543609733","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":1222,"gross_charge":1286,"discounted_cash":1286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":733}]}]},{"description":"55250 Vasectomy, Unilateral Or Bilateral (Separate Procedure), W/postoperative Semen Exam(s) Charge","code_information":[{"code":"20055250","type":"CDM"},{"code":"521","type":"RC"},{"code":"55250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":449,"maximum":1219,"gross_charge":1283,"discounted_cash":1283,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":731}]}]},{"description":"Laparoscopic Sealer Maryland Jaw","code_information":[{"code":"1601812","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601812","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":1210,"gross_charge":1274,"discounted_cash":1274,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1210},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726}]}]},{"description":"12041 Repair Intermediate N/h/f/xtrnl Gent 2.5cm/< Techfee","code_information":[{"code":"13512041","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":1209,"gross_charge":1273,"discounted_cash":1273,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1184},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726}]}]},{"description":"Hcv Reflex Genotype Pspc","code_information":[{"code":"35087902P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":1209,"gross_charge":1273,"discounted_cash":1273,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1184},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726}]}]},{"description":"Blood Transfusion 4-6 Hrsobs","code_information":[{"code":"105364302","type":"CDM"},{"code":"762","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445,"maximum":1207,"gross_charge":1271,"discounted_cash":1271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":724}]}]},{"description":"Blood Transfusion 4-6 Hrs Non-ed","code_information":[{"code":"145364302","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445,"maximum":1207,"gross_charge":1271,"discounted_cash":1271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":724}]}]},{"description":"64450 Inj Anes Oth Per Nerve","code_information":[{"code":"12564450","type":"CDM"},{"code":"360","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":444,"maximum":1205,"gross_charge":1268,"discounted_cash":1268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":723}]}]},{"description":"Mesh Symbotex 15x10","code_information":[{"code":"1601704","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601704","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":444,"maximum":1205,"gross_charge":1268,"discounted_cash":1268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":723}]}]},{"description":"Mesh Ultrapro Large","code_information":[{"code":"1601516","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601516","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":442,"maximum":1201,"gross_charge":1264,"discounted_cash":1264,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720}]}]},{"description":"Us Duplex Hemodialysis Access Flow","code_information":[{"code":"38093990","type":"CDM"},{"code":"402","type":"RC"},{"code":"93990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":1196,"gross_charge":1259,"discounted_cash":1259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":718}]}]},{"description":"Ultane/suprane Charge","code_information":[{"code":"130006","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP130006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":439,"maximum":1191,"gross_charge":1254,"discounted_cash":1254,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1191},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":715}]}]},{"description":"Blood Transfusion 4-6 Hrs","code_information":[{"code":"135364302","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":437,"maximum":1186,"gross_charge":1248,"discounted_cash":1248,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":711}]}]},{"description":"Test Name Pspc","code_information":[{"code":"35081408","type":"CDM"},{"code":"301","type":"RC"},{"code":"81408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":1174,"gross_charge":1236,"discounted_cash":1236,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1149},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":705}]}]},{"description":"Test Result Pspc","code_information":[{"code":"35081479","type":"CDM"},{"code":"301","type":"RC"},{"code":"81479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":1174,"gross_charge":1236,"discounted_cash":1236,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1149},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":705}]}]},{"description":"Alphavent Punch-tap 4.75mm","code_information":[{"code":"1602076","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":1168,"gross_charge":1229,"discounted_cash":1229,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":701}]}]},{"description":"Cyclophosphamide 1 Gm Vial [Chas]","code_information":[{"code":"CP17640152376467665","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019095601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":429,"maximum":1166,"gross_charge":1227,"discounted_cash":1227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":699}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ventralex Mesh Large","code_information":[{"code":"1601542","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601542","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":427,"maximum":1158,"gross_charge":1219,"discounted_cash":1219,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":695}]}]},{"description":"Inject Sacroliliac Joint Charge","code_information":[{"code":"12527096","type":"CDM"},{"code":"360","type":"RC"},{"code":"27096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":426,"maximum":1155,"gross_charge":1216,"discounted_cash":1216,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":693}]}]},{"description":"Xr Fluoro Ivp","code_information":[{"code":"36074400","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":425,"maximum":1153,"gross_charge":1214,"discounted_cash":1214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":692}]}]},{"description":"Alpha 1-proteinase Inhibitor Human Sol [Chas]","code_information":[{"code":"CP17640152376436423","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533070501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":418,"maximum":1135,"gross_charge":1195,"discounted_cash":1195,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":681}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"32555-aspirate Pleura W/imaginged Tech","code_information":[{"code":"12532555","type":"CDM"},{"code":"450","type":"RC"},{"code":"32555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":417,"maximum":1131,"gross_charge":1190,"discounted_cash":1190,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1107},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":678}]}]},{"description":"99291critical Care First Hour -Tech","code_information":[{"code":"10599291","type":"CDM"},{"code":"110","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":1119,"gross_charge":1178,"discounted_cash":1178,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":671}]}]},{"description":"36593- Declot Vascular Device -Er Tech","code_information":[{"code":"13536593","type":"CDM"},{"code":"450","type":"RC"},{"code":"36593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":411,"maximum":1115,"gross_charge":1174,"discounted_cash":1174,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1092},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":669}]}]},{"description":"Hepatitis B Virus (Hbv) Pspc","code_information":[{"code":"35087517P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":410,"maximum":1112,"gross_charge":1170,"discounted_cash":1170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1088},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":667}]}]},{"description":"Lumbar Puncture Tech Chg","code_information":[{"code":"14562270","type":"CDM"},{"code":"761","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":409,"maximum":1110,"gross_charge":1168,"discounted_cash":1168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1086},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":666}]}]},{"description":"Xr Fluoro Guidance For Central Venous Ac","code_information":[{"code":"36077001","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":408,"maximum":1109,"gross_charge":1167,"discounted_cash":1167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1109},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665}]}]},{"description":"Anchor Biocomposite Pushlock","code_information":[{"code":"1601910","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601910","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":1102,"gross_charge":1160,"discounted_cash":1160,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":661}]}]},{"description":"Injection(s), Diagnostic Or Therapeutic Agent, Paravertebral Facet Joint (Or Nerves Innervating That","code_information":[{"code":"12564494","type":"CDM"},{"code":"360","type":"RC"},{"code":"64494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":404,"maximum":1095,"gross_charge":1153,"discounted_cash":1153,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1072},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1095},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":657}]}]},{"description":"D/m Vit Beaded Cable/sleeve Set","code_information":[{"code":"1601879","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":1091,"gross_charge":1148,"discounted_cash":1148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1091},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":654}]}]},{"description":"Jak2 V617f Mutation Detection (Rps) Pspc","code_information":[{"code":"35081270P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":1090,"gross_charge":1147,"discounted_cash":1147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1067},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1090},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"Ligasure Blunt Tip","code_information":[{"code":"1600565","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600565","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":1089,"gross_charge":1146,"discounted_cash":1146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1066},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1089},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":653}]}]},{"description":"Nerve Block Other Peripheral","code_information":[{"code":"13564450","type":"CDM"},{"code":"450","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":1088,"gross_charge":1145,"discounted_cash":1145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1065},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1088},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":653}]}]},{"description":"59200 Insert Cervical Dilatorop Tech","code_information":[{"code":"12559200","type":"CDM"},{"code":"761","type":"RC"},{"code":"59200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":1088,"gross_charge":1145,"discounted_cash":1145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1065},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1088},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":653}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"38076700","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":400,"maximum":1086,"gross_charge":1143,"discounted_cash":1143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1063},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1086},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":652}]}]},{"description":"Us Upper Exremity Arterial Duplex Left","code_information":[{"code":"38093931L-LT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":398,"maximum":1080,"gross_charge":1137,"discounted_cash":1137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1057},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":648}]}]},{"description":"Us Upper Extremity Arterial Duplex Right","code_information":[{"code":"38093931R-RT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":398,"maximum":1080,"gross_charge":1137,"discounted_cash":1137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1057},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":648}]}]},{"description":"Us Segmental Pressure W/ Exercise","code_information":[{"code":"38093924","type":"CDM"},{"code":"402","type":"RC"},{"code":"93924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":395,"maximum":1072,"gross_charge":1128,"discounted_cash":1128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1049},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1072},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":643}]}]},{"description":"Filgrastim 480 Mcg/0.8 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376477871","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":393,"maximum":1068,"gross_charge":1124,"discounted_cash":1124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1068},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":641}]}],"drug_information":{"unit":480,"type":"ML"}},{"description":"Inj For Sacroiliac Joint, Provision Of Anesthetic","code_information":[{"code":"125G0260","type":"CDM"},{"code":"360","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":393,"maximum":1066,"gross_charge":1122,"discounted_cash":1122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1066},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":640}]}]},{"description":"General Anesthesia Charge","code_information":[{"code":"130003","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP130003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":386,"maximum":1047,"gross_charge":1102,"discounted_cash":1102,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1047},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628}]}]},{"description":"11441- Exc Face-mm B9 + Marg 0.61cm -Surg Tech","code_information":[{"code":"12511441","type":"CDM"},{"code":"360","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":385,"maximum":1045,"gross_charge":1100,"discounted_cash":1100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":627}]}]},{"description":"64486-tap Block Unil By Injection-surg Tech","code_information":[{"code":"12564486","type":"CDM"},{"code":"360","type":"RC"},{"code":"64486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":384,"maximum":1042,"gross_charge":1097,"discounted_cash":1097,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1020},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":625}]}]},{"description":"Us Carotid Duplex Left","code_information":[{"code":"38093882LT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":1036,"gross_charge":1091,"discounted_cash":1091,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":622}]}]},{"description":"Us Carotid Duplex Right","code_information":[{"code":"38093882RT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":1036,"gross_charge":1091,"discounted_cash":1091,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":622}]}]},{"description":"Us Echocardiogram Limited","code_information":[{"code":"38093308","type":"CDM"},{"code":"483","type":"RC"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":1036,"gross_charge":1091,"discounted_cash":1091,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":622}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"14029881","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":1036,"gross_charge":1091,"discounted_cash":1091,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":622}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"CP17640152543599992","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":382,"maximum":1036,"gross_charge":1091,"discounted_cash":1091,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":622}]}]},{"description":"Myelin Oligodendrocyte Glycoprotein Igg (Rps) Pspc","code_information":[{"code":"35086255P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":380,"maximum":1033,"gross_charge":1087,"discounted_cash":1087,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1011},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":620}]}]},{"description":"Exc Tr-ext Mal-marg]4 Cm","code_information":[{"code":"20011606","type":"CDM"},{"code":"521","type":"RC"},{"code":"11606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379,"maximum":1030,"gross_charge":1084,"discounted_cash":1084,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1030},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":618}]}]},{"description":"92953 Temporary External Pacing","code_information":[{"code":"13592953","type":"CDM"},{"code":"450","type":"RC"},{"code":"92953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379,"maximum":1028,"gross_charge":1082,"discounted_cash":1082,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1006},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":617}]}]},{"description":"Filgrastim 480 Mcg/1.6 Ml Sol [Chas]","code_information":[{"code":"CP17640152376484353","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":377,"maximum":1023,"gross_charge":1077,"discounted_cash":1077,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1002},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":614}]}],"drug_information":{"unit":480,"type":"ML"}},{"description":"Us Le Arterial Duplex Bilateral","code_information":[{"code":"38093925","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":376,"maximum":1021,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":613}]}]},{"description":"Us Lower Extremity Arterial Duplex Left","code_information":[{"code":"38093926L-LT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":376,"maximum":1021,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":613}]}]},{"description":"Us Lower Extremity Arterial Duplex Right","code_information":[{"code":"38093926R-RT","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":376,"maximum":1021,"gross_charge":1075,"discounted_cash":1075,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":613}]}]},{"description":"D/m Vit Cable/sleeve Set","code_information":[{"code":"1601819","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601819","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":376,"maximum":1019,"gross_charge":1073,"discounted_cash":1073,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1019},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":612}]}]},{"description":"Micro Acutrak 2 Bone Screw","code_information":[{"code":"1601773","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601773","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":1017,"gross_charge":1071,"discounted_cash":1071,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":996},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":610}]}]},{"description":"Room/bed: Nursery","code_information":[{"code":"115000","type":"CDM"},{"code":"171","type":"RC"},{"code":"CP115000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":375,"maximum":1017,"gross_charge":1070,"discounted_cash":1070,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":995},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":610}]}]},{"description":"Blood Transfusion 2-4 Hrsobs","code_information":[{"code":"105364301","type":"CDM"},{"code":"762","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":373,"maximum":1012,"gross_charge":1065,"discounted_cash":1065,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1012},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":607}]}]},{"description":"Blood Transfusion 2-4 Hrs Non-ed","code_information":[{"code":"145364301","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":373,"maximum":1012,"gross_charge":1065,"discounted_cash":1065,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1012},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":607}]}]},{"description":"20553 Injection Single/mlt Trigger Point 3/> Muscles Techfee","code_information":[{"code":"13520553","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":372,"maximum":1011,"gross_charge":1064,"discounted_cash":1064,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1011},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":606}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"38076805","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":1008,"gross_charge":1061,"discounted_cash":1061,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":987},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605}]}]},{"description":"26770 Tx Interpha Join Dis","code_information":[{"code":"13526770","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":1007,"gross_charge":1060,"discounted_cash":1060,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":986},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":1007},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604}]}]},{"description":"Ligasure Curved","code_information":[{"code":"1600566","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600566","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":999,"gross_charge":1052,"discounted_cash":1052,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":978},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":999},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600}]}]},{"description":"Infliximab 100mg Vial [Chas]","code_information":[{"code":"CP17640152376490402","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":368,"maximum":998,"gross_charge":1051,"discounted_cash":1051,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Or-complex Ea Addl 30 Charge","code_information":[{"code":"125001","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":998,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"Or-intermediate Ea Add 30 Charge","code_information":[{"code":"125003","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":998,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"Or-simple Ea Addl 30 Min Charge","code_information":[{"code":"125006","type":"CDM"},{"code":"360","type":"RC"},{"code":"CP125006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":998,"gross_charge":1050,"discounted_cash":1050,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"Us Retroperitoneal Complete","code_information":[{"code":"38076770","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":992,"gross_charge":1044,"discounted_cash":1044,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":971},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":595}]}]},{"description":"Blood Transfusion 2-4 Hrs","code_information":[{"code":"135364301","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":991,"gross_charge":1043,"discounted_cash":1043,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":970},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":991},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":595}]}]},{"description":"Bard Power Port","code_information":[{"code":"1600072","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600072","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":365,"maximum":990,"gross_charge":1042,"discounted_cash":1042,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":969},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":990},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":594}]}]},{"description":"Us Pelvic Complete","code_information":[{"code":"38076856","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":363,"maximum":984,"gross_charge":1036,"discounted_cash":1036,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":984},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":591}]}]},{"description":"Repair of groin hernia patient age 5 years or older","code_information":[{"code":"14049505","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"49505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":358,"maximum":973,"gross_charge":1024,"discounted_cash":1024,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":952},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":584}]}]},{"description":"Repair of groin hernia patient age 5 years or older","code_information":[{"code":"CP17640152543601665","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"49505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":358,"maximum":973,"gross_charge":1024,"discounted_cash":1024,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":952},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":584}]}]},{"description":"25605-treat Fracture Radius/ulna-tech","code_information":[{"code":"14025605","type":"CDM"},{"code":"761","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":357,"maximum":969,"gross_charge":1020,"discounted_cash":1020,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":949},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":969},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"Us Joint Left","code_information":[{"code":"38076882L-LT","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":357,"maximum":968,"gross_charge":1019,"discounted_cash":1019,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"Us Joint Right","code_information":[{"code":"38076882R-RT","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":357,"maximum":968,"gross_charge":1019,"discounted_cash":1019,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"27788 Treatment Of Ankle Fracture","code_information":[{"code":"20027810","type":"CDM"},{"code":"521","type":"RC"},{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":357,"maximum":968,"gross_charge":1019,"discounted_cash":1019,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":968},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"27500-closed Treat Femoral Shaft Fract -Ed Tech Bce","code_information":[{"code":"13527500","type":"CDM"},{"code":"450","type":"RC"},{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":355,"maximum":963,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":943},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":578}]}]},{"description":"Xr Bone Survey Complete","code_information":[{"code":"36077075","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":355,"maximum":963,"gross_charge":1014,"discounted_cash":1014,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":943},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":963},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":578}]}]},{"description":"99284 Emergent Care Level 4 Manual -Tech","code_information":[{"code":"13599284","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":354,"maximum":960,"gross_charge":1010,"discounted_cash":1010,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":939},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"20611-drain/inj Joint/bursa W/us -Tech","code_information":[{"code":"12520611","type":"CDM"},{"code":"360","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":954,"gross_charge":1004,"discounted_cash":1004,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":572}]}]},{"description":"Fiberstitch Implant, Curved","code_information":[{"code":"1601954","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":954,"gross_charge":1004,"discounted_cash":1004,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":572}]}]},{"description":"Fiberstitch Implant, Reverse Curve","code_information":[{"code":"1602016","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":954,"gross_charge":1004,"discounted_cash":1004,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":572}]}]},{"description":"Fiberstitch Implant, Straight","code_information":[{"code":"1602017","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":351,"maximum":954,"gross_charge":1004,"discounted_cash":1004,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":572}]}]},{"description":"Xr Cystogram Voiding","code_information":[{"code":"36074455","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":950,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":570}]}]},{"description":"Xr Fluoroscopy Up To 1 Hour","code_information":[{"code":"36076000","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":950,"gross_charge":1000,"discounted_cash":1000,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":570}]}]},{"description":"27508 Fx Clsd Med Cond Wo Manip","code_information":[{"code":"14027508","type":"CDM"},{"code":"510","type":"RC"},{"code":"27508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":948,"gross_charge":998,"discounted_cash":998,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":928},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":569}]}]},{"description":"Phentolamine 5 Mg  Sdv [Chas]","code_information":[{"code":"CP17640152376534477","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":346,"maximum":939,"gross_charge":988,"discounted_cash":988,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":919},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":939},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":563}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"21400- Closed Tx Orbit W/o Manipulj -Er Tech","code_information":[{"code":"13521400","type":"CDM"},{"code":"450","type":"RC"},{"code":"21400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":938,"gross_charge":987,"discounted_cash":987,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":918},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":563}]}]},{"description":"51700 Bladder Irrigation Ed Charge","code_information":[{"code":"13551700","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":938,"gross_charge":987,"discounted_cash":987,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":918},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":563}]}]},{"description":"37195 Thrombolytic Therapy Strokeed Tech","code_information":[{"code":"12537195","type":"CDM"},{"code":"450","type":"RC"},{"code":"37195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":934,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":560}]}]},{"description":"Us Ob < 14 Weeks Multi","code_information":[{"code":"38076802","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":934,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":560}]}]},{"description":"Xr Knee Complete Bilateral","code_information":[{"code":"36073564B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":344,"maximum":934,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":560}]}]},{"description":"Ventralax Hernia Mesh Med","code_information":[{"code":"1601228","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":934,"gross_charge":983,"discounted_cash":983,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":934},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":560}]}]},{"description":"Tacker 5mm","code_information":[{"code":"1601489","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601489","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":343,"maximum":930,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558}]}]},{"description":"Cyclophosphamide 500 Mg Vial [Chas]","code_information":[{"code":"CP17640152376469855","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019095501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":343,"maximum":930,"gross_charge":979,"discounted_cash":979,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Us Breast Bilateral Limited","code_information":[{"code":"38076642B-50","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":342,"maximum":929,"gross_charge":978,"discounted_cash":978,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":910},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":929},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":557}]}]},{"description":"Us Abdominal Aorta Limited","code_information":[{"code":"38093979","type":"CDM"},{"code":"402","type":"RC"},{"code":"93979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":341,"maximum":926,"gross_charge":975,"discounted_cash":975,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":907},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":556}]}]},{"description":"Antepartum Care Only; 4-6 Visits â Clinic","code_information":[{"code":"20059425","type":"CDM"},{"code":"521","type":"RC"},{"code":"59425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":341,"maximum":926,"gross_charge":975,"discounted_cash":975,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":907},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":556}]}]},{"description":"Filgrastim Sndz 480 Mcg/0.8 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376487178","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":341,"maximum":924,"gross_charge":973,"discounted_cash":973,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":555}]}],"drug_information":{"unit":480,"type":"ML"}},{"description":"Mesh Ultrapro Medium","code_information":[{"code":"1600613","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1600613","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":341,"maximum":924,"gross_charge":973,"discounted_cash":973,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":924},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":555}]}]},{"description":"27538-treat Knee Fracture(s)-sc Tech","code_information":[{"code":"14027538","type":"CDM"},{"code":"510","type":"RC"},{"code":"27538","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":340,"maximum":922,"gross_charge":970,"discounted_cash":970,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":922},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":553}]}]},{"description":"Werewolf Fastseal 6.0 Wand","code_information":[{"code":"1602136","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602136","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":919,"gross_charge":967,"discounted_cash":967,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":899},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":919},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":551}]}]},{"description":"32554 Thoracentesis W/o Guidanceed Tech","code_information":[{"code":"12532554","type":"CDM"},{"code":"450","type":"RC"},{"code":"32554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":915,"gross_charge":963,"discounted_cash":963,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":549}]}]},{"description":"Us Head/neck Soft Tissue","code_information":[{"code":"38076536","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":915,"gross_charge":963,"discounted_cash":963,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":549}]}]},{"description":"3.0 Double Loaded Suturetak, Suture Anchor","code_information":[{"code":"1601975","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601975","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":915,"gross_charge":963,"discounted_cash":963,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":549}]}]},{"description":"27788 Treatment Ankle Fx With Med Tech","code_information":[{"code":"12527788","type":"CDM"},{"code":"450","type":"RC"},{"code":"27788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":914,"gross_charge":962,"discounted_cash":962,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":895},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":914},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":548}]}]},{"description":"27550treat Knee Dislocationsc Tech","code_information":[{"code":"14027550","type":"CDM"},{"code":"510","type":"RC"},{"code":"27550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":913,"gross_charge":961,"discounted_cash":961,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":894},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":913},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":548}]}]},{"description":"94660 Cpap/bipap Charge","code_information":[{"code":"30094660","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":912,"gross_charge":960,"discounted_cash":960,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547}]}]},{"description":"Suture Anchor, Bio-composite Suturetak","code_information":[{"code":"1601695","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601695","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":335,"maximum":908,"gross_charge":956,"discounted_cash":956,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":545}]}]},{"description":"Nmo Igg Ab, Pspc","code_information":[{"code":"35083516P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":334,"maximum":905,"gross_charge":953,"discounted_cash":953,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":886},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":905},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543}]}]},{"description":"12052 Rpr Intrm Face 2.6-5.0ed Tech","code_information":[{"code":"12512052","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":333,"maximum":903,"gross_charge":950,"discounted_cash":950,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":903},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":542}]}]},{"description":"29085-apply Hand/wrist Casted Tech","code_information":[{"code":"12529085","type":"CDM"},{"code":"450","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":332,"maximum":902,"gross_charge":949,"discounted_cash":949,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":883},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541}]}]},{"description":"Revision Or Removal Of Peripheral Neurostimulator Pulse Generator Or Receiver","code_information":[{"code":"12564495","type":"CDM"},{"code":"360","type":"RC"},{"code":"64495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":897,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":538}]}]},{"description":"Ultrasound pelvis through vagina","code_information":[{"code":"38076830","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":897,"gross_charge":944,"discounted_cash":944,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":538}]}]},{"description":"12020- Closure Of Split Wound -Er Tech","code_information":[{"code":"13512020","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":896,"gross_charge":943,"discounted_cash":943,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":896},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":538}]}]},{"description":"28475 Closed Tx Of Metatarsal Fx, With Manipulation Each","code_information":[{"code":"14028470","type":"CDM"},{"code":"510","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330,"maximum":895,"gross_charge":942,"discounted_cash":942,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":876},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":895},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":537}]}]},{"description":"Parvovirus B19 Dna Detection (Rps) Pspc","code_information":[{"code":"35087798DP","type":"CDM"},{"code":"302","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":886,"gross_charge":933,"discounted_cash":933,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":868},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":886},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}]},{"description":"Xr Knee 3 Views Bilateral","code_information":[{"code":"36073562B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":326,"maximum":884,"gross_charge":931,"discounted_cash":931,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":531}]}]},{"description":"Mesh V-patch 6.4cm X 6.4cm","code_information":[{"code":"1601577","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601577","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":324,"maximum":879,"gross_charge":925,"discounted_cash":925,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":527}]}]},{"description":"11626-exc. Malignant Lesion Including Margins, Scalp, Neck, Hands, Ft, Genetalia; Over 4.0 Cm","code_information":[{"code":"20011626","type":"CDM"},{"code":"521","type":"RC"},{"code":"11626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":873,"gross_charge":919,"discounted_cash":919,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":873},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":524}]}]},{"description":"27788 Tx Of Ankle Fractureclinic","code_information":[{"code":"20027788","type":"CDM"},{"code":"521","type":"RC"},{"code":"27788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":321,"maximum":872,"gross_charge":918,"discounted_cash":918,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523}]}]},{"description":"Us Abdomen Limited","code_information":[{"code":"38076705","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":320,"maximum":867,"gross_charge":913,"discounted_cash":913,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":849},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":867},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":520}]}]},{"description":"Gastrointestinal Pathogen Panel, Pcr Pspc","code_information":[{"code":"35087999","type":"CDM"},{"code":"310","type":"RC"},{"code":"87999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":319,"maximum":866,"gross_charge":912,"discounted_cash":912,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":848},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":520}]}]},{"description":"Us Aaa Screening","code_information":[{"code":"38076706","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":319,"maximum":866,"gross_charge":912,"discounted_cash":912,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":848},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":520}]}]},{"description":"Screw Crossdeck","code_information":[{"code":"1601835","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":318,"maximum":864,"gross_charge":909,"discounted_cash":909,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":845},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":518}]}]},{"description":"24500 Treat Humerus Fracture","code_information":[{"code":"13524500","type":"CDM"},{"code":"450","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":317,"maximum":862,"gross_charge":907,"discounted_cash":907,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":517}]}]},{"description":"12044 Intmd Rpr N-hf/genit 7.6-12.5cmed Tech","code_information":[{"code":"12512044","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":317,"maximum":862,"gross_charge":907,"discounted_cash":907,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":517}]}]},{"description":"Xr Hand Complete Bilateral","code_information":[{"code":"36073130BI-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":317,"maximum":862,"gross_charge":907,"discounted_cash":907,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":862},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":517}]}]},{"description":"62270 Spinal Tap Dxed Tech","code_information":[{"code":"12562270","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":316,"maximum":858,"gross_charge":903,"discounted_cash":903,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":858},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":515}]}]},{"description":"Xr Foot Complete Bilateral","code_information":[{"code":"36073630B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":316,"maximum":858,"gross_charge":903,"discounted_cash":903,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":858},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":515}]}]},{"description":"27840 Treat Ankle Dislocationed Tech","code_information":[{"code":"12527840","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":314,"maximum":851,"gross_charge":896,"discounted_cash":896,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":511}]}]},{"description":"11760 Repair Of Nail Beded Tech","code_information":[{"code":"12511760","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":312,"maximum":846,"gross_charge":890,"discounted_cash":890,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":507}]}]},{"description":"Tbo-filgrastim 480 Mcg/0.8 Ml [Chas]","code_information":[{"code":"CP17640152376554755","type":"CDM"},{"code":"250","type":"RC"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":311,"maximum":845,"gross_charge":889,"discounted_cash":889,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":845},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":507}]}],"drug_information":{"unit":480,"type":"ML"}},{"description":"Us Scrotum (Contents)","code_information":[{"code":"38076870","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309,"maximum":840,"gross_charge":884,"discounted_cash":884,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":504}]}]},{"description":"Surgimesh Xb 7 Cm","code_information":[{"code":"1602038","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":309,"maximum":840,"gross_charge":884,"discounted_cash":884,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":504}]}]},{"description":"Us Chest","code_information":[{"code":"38076604","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309,"maximum":838,"gross_charge":882,"discounted_cash":882,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":820},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":503}]}]},{"description":"12031 Intmd Rpr S/a/t/ext 2.5 Cm/<ed Tech","code_information":[{"code":"12512031","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":832,"gross_charge":876,"discounted_cash":876,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":499}]}]},{"description":"25600-treat Fracture Radius/ulna-sc Tech","code_information":[{"code":"14025600","type":"CDM"},{"code":"510","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":831,"gross_charge":875,"discounted_cash":875,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":814},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":499}]}]},{"description":"Us Ob < 14 Weeks Single","code_information":[{"code":"38076801","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":828,"gross_charge":872,"discounted_cash":872,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":497}]}]},{"description":"28660 Closed Tx Of Interphalageal Joint Dislocation; With Anesthesia","code_information":[{"code":"13528665","type":"CDM"},{"code":"450","type":"RC"},{"code":"28665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":827,"gross_charge":871,"discounted_cash":871,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":810},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":496}]}]},{"description":"28665 Tx Toe Dislocation, With Manipulation;w/ Anes","code_information":[{"code":"20026775","type":"CDM"},{"code":"521","type":"RC"},{"code":"26775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":827,"gross_charge":871,"discounted_cash":871,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":810},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":496}]}]},{"description":"12034-rpr Intmed Wound-s/a/t/e 7.6-12.5 Cm-ed Tech","code_information":[{"code":"13512034","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303,"maximum":823,"gross_charge":866,"discounted_cash":866,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":805},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":823},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":494}]}]},{"description":"Screw Snap Off","code_information":[{"code":"1601884","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601884","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":816,"gross_charge":859,"discounted_cash":859,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":490}]}]},{"description":"Blood Transfusion 2 Hrs- Obs","code_information":[{"code":"105364300","type":"CDM"},{"code":"762","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":813,"gross_charge":856,"discounted_cash":856,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":488}]}]},{"description":"Blood Transfusion <2 Hrs Non-ed","code_information":[{"code":"145364300","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":813,"gross_charge":856,"discounted_cash":856,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":488}]}]},{"description":"26605 Treat Metacarpal Fxed Tech","code_information":[{"code":"12526605","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":812,"gross_charge":855,"discounted_cash":855,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":795},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":487}]}]},{"description":"Us Segmental Pressure Complete","code_information":[{"code":"38093923","type":"CDM"},{"code":"402","type":"RC"},{"code":"93923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":812,"gross_charge":855,"discounted_cash":855,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":795},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":487}]}]},{"description":"Igh Gene Rearrange Unmc Pspc","code_information":[{"code":"35081261INMC","type":"CDM"},{"code":"300","type":"RC"},{"code":"81261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":808,"gross_charge":851,"discounted_cash":851,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":485}]}]},{"description":"12032 Intmd Rpr S/a/t/ext 2.6-7.5ed Tech","code_information":[{"code":"12512032","type":"CDM"},{"code":"360","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":808,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":484}]}]},{"description":"Xr Knee One Or Two Views Bilateral","code_information":[{"code":"36073560B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":298,"maximum":808,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":484}]}]},{"description":"Rabies Vaccine, Purified Chick Embyro Cell 2.5 Intl Units Im Inj[chas]","code_information":[{"code":"CP17640152376540956","type":"CDM"},{"code":"250","type":"RC"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":295,"maximum":802,"gross_charge":844,"discounted_cash":844,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":785},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":802},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481}]}],"drug_information":{"unit":25,"type":"UN"}},{"description":"Cutter Articulating Linear 340mm Shaft","code_information":[{"code":"1601829","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601829","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":801,"gross_charge":843,"discounted_cash":843,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":801},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"Suture Anchor, Biocom Swivelock C, Closed Eyelet","code_information":[{"code":"1601936","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601936","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":801,"gross_charge":843,"discounted_cash":843,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":801},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481}]}]},{"description":"24530 Treat Humerus Fracture-clinic","code_information":[{"code":"20024530","type":"CDM"},{"code":"521","type":"RC"},{"code":"24530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294,"maximum":799,"gross_charge":841,"discounted_cash":841,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":479}]}]},{"description":"Blood Transfusion <2 Hrs","code_information":[{"code":"135364300","type":"CDM"},{"code":"450","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294,"maximum":797,"gross_charge":839,"discounted_cash":839,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":780},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":797},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":478}]}]},{"description":"27500-closed Trmnt Femoral Shaft Fract W/o Manp-sc Tech","code_information":[{"code":"14027500","type":"CDM"},{"code":"510","type":"RC"},{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":293,"maximum":796,"gross_charge":838,"discounted_cash":838,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":779},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":796},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":478}]}]},{"description":"Membrane Wrap 2x2cm (4cm Sq.)","code_information":[{"code":"1602096","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":793,"gross_charge":835,"discounted_cash":835,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":476}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Membrane Wrap 4x4cm (16cm Sq.)","code_information":[{"code":"1602101","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":793,"gross_charge":835,"discounted_cash":835,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":476}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Membrane Wrap 4x6cm (24 Cm Sq) â 1 Cm Sq","code_information":[{"code":"1602094","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":793,"gross_charge":835,"discounted_cash":835,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":476}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Membrane Wrap 4x8cm (32 Cm Sq) â 1 Cm Sq","code_information":[{"code":"1602093","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":793,"gross_charge":835,"discounted_cash":835,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":777},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":476}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Xr Cholangiogram In Or","code_information":[{"code":"36074300","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":290,"maximum":787,"gross_charge":828,"discounted_cash":828,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":787},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":472}]}]},{"description":"59812-treatment Of Miscarriage-edtech","code_information":[{"code":"13559812","type":"CDM"},{"code":"450","type":"RC"},{"code":"59812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":783,"gross_charge":824,"discounted_cash":824,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":470}]}]},{"description":"Us Guidance Needle Placement","code_information":[{"code":"38076937","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":783,"gross_charge":824,"discounted_cash":824,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":470}]}]},{"description":"Vertralix Hernia Mesh Sm","code_information":[{"code":"1601236","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":782,"gross_charge":823,"discounted_cash":823,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":469}]}]},{"description":"Removal of one or more breast growth, open procedure","code_information":[{"code":"14019120","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"19120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":782,"gross_charge":823,"discounted_cash":823,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":469}]}]},{"description":"Removal of one or more breast growth, open procedure","code_information":[{"code":"CP17640152543576518","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"19120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":782,"gross_charge":823,"discounted_cash":823,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":469}]}]},{"description":"Xr Small Bowel Series","code_information":[{"code":"36074250","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":287,"maximum":778,"gross_charge":819,"discounted_cash":819,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467}]}]},{"description":"25560-treat Fx Radius And Ulna-tech","code_information":[{"code":"13525560","type":"CDM"},{"code":"450","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":776,"gross_charge":817,"discounted_cash":817,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466}]}]},{"description":"27808 Closed Treatment Of Bimalleolar Ankle Fracture (Eg, Lateral","code_information":[{"code":"13527808","type":"CDM"},{"code":"450","type":"RC"},{"code":"27808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":286,"maximum":776,"gross_charge":817,"discounted_cash":817,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466}]}]},{"description":"Immune Globulin Iv-sq 10% Sol2.5 Gm/25 Ml  [Chas]","code_information":[{"code":"CP17640152376496632","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":285,"maximum":773,"gross_charge":814,"discounted_cash":814,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":464}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Anchor Suture Bio-comp Pushlock","code_information":[{"code":"1601926","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601926","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":284,"maximum":770,"gross_charge":811,"discounted_cash":811,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":462}]}]},{"description":"T Gamma Gene Rearrange Unmc Pspc","code_information":[{"code":"35081342UNMC","type":"CDM"},{"code":"300","type":"RC"},{"code":"81342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":768,"gross_charge":808,"discounted_cash":808,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":461}]}]},{"description":"Screw Cannulated Partially Threaded","code_information":[{"code":"1601600","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601600","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":766,"gross_charge":806,"discounted_cash":806,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":750},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":766},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459}]}]},{"description":"Braf Mutation Detection Unmc Pspc","code_information":[{"code":"35081210","type":"CDM"},{"code":"310","type":"RC"},{"code":"81210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":764,"gross_charge":804,"discounted_cash":804,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":748},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":764},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":458}]}]},{"description":"Pain Pump 400 Ml","code_information":[{"code":"1601597","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601597","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":762,"gross_charge":802,"discounted_cash":802,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":457}]}]},{"description":"Screw Locking","code_information":[{"code":"1601603","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601603","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":280,"maximum":760,"gross_charge":800,"discounted_cash":800,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":456}]}]},{"description":"Xr Spine Cervical 6 Or More Views","code_information":[{"code":"36072052","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":755,"gross_charge":795,"discounted_cash":795,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":755},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":453}]}]},{"description":"Fetal Fibronectin, Pspc","code_information":[{"code":"35082731P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82731","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":754,"gross_charge":794,"discounted_cash":794,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":453}]}]},{"description":"Screw Locking 10 Full Thread 3.5mm","code_information":[{"code":"1601983","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":752,"gross_charge":792,"discounted_cash":792,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":737},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":752},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"Carboprost 250 Mcg/ml1 Ml[chas]","code_information":[{"code":"CP17640152376451865","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":277,"maximum":751,"gross_charge":791,"discounted_cash":791,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":736},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"27301drain Thigh/knee Lesionsc Tech","code_information":[{"code":"14027301","type":"CDM"},{"code":"510","type":"RC"},{"code":"27301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":751,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Us Ob>14weeks Add Gestational","code_information":[{"code":"38076810","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":751,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Closed Tx Of Patellar Dislocation; Without Anesthesia","code_information":[{"code":"20027560","type":"CDM"},{"code":"521","type":"RC"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":751,"gross_charge":790,"discounted_cash":790,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Xr Ankle Complete Bilateral","code_information":[{"code":"36073610B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":275,"maximum":746,"gross_charge":785,"discounted_cash":785,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":447}]}]},{"description":"Closed Trtmt Of Humeral Shaft Fx; W/o Manipulation Charge","code_information":[{"code":"20024500","type":"CDM"},{"code":"521","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":744,"gross_charge":783,"discounted_cash":783,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":728},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":446}]}]},{"description":"Sodium Hyaluronate 1% 10 Mg/ml2 Ml [Chas]","code_information":[{"code":"CP17640152376554853","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566410001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":273,"maximum":742,"gross_charge":781,"discounted_cash":781,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":445}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"M0245- Intrav Infus Bamlanivimab/etesevimab-tech","code_information":[{"code":"135M0245","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":273,"maximum":742,"gross_charge":781,"discounted_cash":781,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":445}]}]},{"description":"M0245-intrav Infus Bamlanivimab/etesevimab-tech","code_information":[{"code":"145M0245","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":273,"maximum":742,"gross_charge":781,"discounted_cash":781,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":445}]}]},{"description":"Drainage Of Arm Lesion","code_information":[{"code":"20023930","type":"CDM"},{"code":"521","type":"RC"},{"code":"23930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":273,"maximum":742,"gross_charge":781,"discounted_cash":781,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":445}]}]},{"description":"Xr Ribs 3 Views Bilateral","code_information":[{"code":"36071110","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":271,"maximum":736,"gross_charge":775,"discounted_cash":775,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":736},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":442}]}]},{"description":"Us Cardiac Holter Monitor 24 Hour","code_information":[{"code":"36093225","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":271,"maximum":735,"gross_charge":774,"discounted_cash":774,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":441}]}]},{"description":"12042 Intmd Rpr N-hf/genit 2.6-7.5ed Tech","code_information":[{"code":"13512042","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":732,"gross_charge":771,"discounted_cash":771,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":439}]}]},{"description":"Sodium Hyaluronate 16.8 Mg/2 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376550134","type":"CDM"},{"code":"250","type":"RC"},{"code":"89130311101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":270,"maximum":732,"gross_charge":770,"discounted_cash":770,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":439}]}],"drug_information":{"unit":168,"type":"ME"}},{"description":"Chemo Iv Infusion 1 Hr","code_information":[{"code":"14596413","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":732,"gross_charge":770,"discounted_cash":770,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":439}]}]},{"description":"23600 Closed Trtmt Of Proximal Humeral (Surgical Or Anatomical Neck) Fx; W/o Manipulation Charge","code_information":[{"code":"14023600","type":"CDM"},{"code":"510","type":"RC"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":731,"gross_charge":769,"discounted_cash":769,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":731},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":438}]}]},{"description":"Amino Acid Profile Quant Pspc","code_information":[{"code":"35082139P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":730,"gross_charge":768,"discounted_cash":768,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":438}]}]},{"description":"Cpt, Initial","code_information":[{"code":"30094669","type":"CDM"},{"code":"410","type":"RC"},{"code":"94669","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":730,"gross_charge":768,"discounted_cash":768,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":438}]}]},{"description":"Xr Abdomen Series W/ Chest1 View","code_information":[{"code":"36074022","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":267,"maximum":724,"gross_charge":762,"discounted_cash":762,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":724},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":434}]}]},{"description":"Xr Spine Entire Min 6 Views","code_information":[{"code":"36072084","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":267,"maximum":724,"gross_charge":762,"discounted_cash":762,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":724},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":434}]}]},{"description":"Fatty Acid Profile, Essential (Rps) Pspc","code_information":[{"code":"35082542PSPC","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":722,"gross_charge":760,"discounted_cash":760,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":433}]}]},{"description":"94060 Bronchospasm Evaluation Charge","code_information":[{"code":"30094060","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":722,"gross_charge":760,"discounted_cash":760,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":433}]}]},{"description":"Fiberwire Suture Kit","code_information":[{"code":"1601846","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601846","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":722,"gross_charge":760,"discounted_cash":760,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":433}]}]},{"description":"16020 Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Small Techfee","code_information":[{"code":"13516020","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":721,"gross_charge":759,"discounted_cash":759,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":433}]}]},{"description":"Ultrafast-fix Ab Curved Needle Delivery System","code_information":[{"code":"1601720","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601720","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":266,"maximum":721,"gross_charge":759,"discounted_cash":759,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":433}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"12555700","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":720,"gross_charge":758,"discounted_cash":758,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":705},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":432}]}]},{"description":"12051 Intmd Rpr Face/mm 2.5 Cm/<ed Tech","code_information":[{"code":"12512051","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":718,"gross_charge":756,"discounted_cash":756,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":703},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":431}]}]},{"description":"27750 Closed Fracture Of Tibial Shaft (With Or Without Fibular Fracture) Without Manipulation","code_information":[{"code":"20027750","type":"CDM"},{"code":"521","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":718,"gross_charge":756,"discounted_cash":756,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":703},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":431}]}]},{"description":"90675 Rabies Vaccine (Rabavert) Im [Chas]","code_information":[{"code":"20090675","type":"CDM"},{"code":"521","type":"RC"},{"code":"90675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":717,"gross_charge":755,"discounted_cash":755,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"28515 Treatment Of Toe Fractureop Tech","code_information":[{"code":"14028515","type":"CDM"},{"code":"761","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":715,"gross_charge":753,"discounted_cash":753,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":429}]}]},{"description":"32551insertion Of Chest Tube -Ed Tech","code_information":[{"code":"13532551","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":713,"gross_charge":751,"discounted_cash":751,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":428}]}]},{"description":"Carbofix Locking Shaft Screw 3.5 L=14","code_information":[{"code":"1602144","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":713,"gross_charge":751,"discounted_cash":751,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":428}]}]},{"description":"Carbofix Locking Shaft Screw 3.5 L=12","code_information":[{"code":"1602143","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602143","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":713,"gross_charge":751,"discounted_cash":751,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":428}]}]},{"description":"Penicillin G Benzathine 1,200,000 Units/2 Ml Sus[chas]","code_information":[{"code":"CP17640152376533737","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":263,"maximum":713,"gross_charge":750,"discounted_cash":750,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":427}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"27750 Fx Tib Shft Clsd Wo Manip","code_information":[{"code":"14027750","type":"CDM"},{"code":"510","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":262,"maximum":711,"gross_charge":748,"discounted_cash":748,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":711},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426}]}]},{"description":"Irradiated","code_information":[{"code":"350P9040","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":710,"gross_charge":747,"discounted_cash":747,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":695},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":710},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":426}]}]},{"description":"26725 Treatment Finger Fracture Eached Tech","code_information":[{"code":"12526725","type":"CDM"},{"code":"450","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":709,"gross_charge":746,"discounted_cash":746,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":425}]}]},{"description":"Xr Wrist Complete Bilateral","code_information":[{"code":"36073110B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":260,"maximum":707,"gross_charge":744,"discounted_cash":744,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":692},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":424}]}]},{"description":"13121-cmplx Rpr S/a/l 2.6-7.5 Cm Tech","code_information":[{"code":"13513121","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":706,"gross_charge":743,"discounted_cash":743,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":424}]}]},{"description":"Carbofix Non-locking Shaft Screw 3.5 L=14","code_information":[{"code":"1602142","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":259,"maximum":704,"gross_charge":741,"discounted_cash":741,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"12041 Intmd Rpr N-hf/genit 2.5 Cm/<ed Tech","code_information":[{"code":"12512041","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":699,"gross_charge":736,"discounted_cash":736,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":699},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":420}]}]},{"description":"Reunion Tsa Univer Humeral Neck Adapter","code_information":[{"code":"1601742","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601742","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":694,"gross_charge":731,"discounted_cash":731,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":417}]}]},{"description":"Spinal Anesthesia Charge","code_information":[{"code":"130005","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP130005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":694,"gross_charge":730,"discounted_cash":730,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":679},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":694},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":416}]}]},{"description":"Us Pregnancy Transvaginal","code_information":[{"code":"38076817","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":691,"gross_charge":727,"discounted_cash":727,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":414}]}]},{"description":"Explore/treat Finger Joint","code_information":[{"code":"20026075","type":"CDM"},{"code":"521","type":"RC"},{"code":"26075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":689,"gross_charge":725,"discounted_cash":725,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":413}]}]},{"description":"25600 Closed Trt Of Distal Radial Fracture (Eg Colles Or Smith Type) Or Epiphyseal Separation-clinic","code_information":[{"code":"20025600","type":"CDM"},{"code":"521","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":254,"maximum":689,"gross_charge":725,"discounted_cash":725,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":413}]}]},{"description":"J0561 Pencillin G Benz 1.2 Mu [Chas]","code_information":[{"code":"200J056112","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":253,"maximum":688,"gross_charge":724,"discounted_cash":724,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":688},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":413}]}]},{"description":"24576 Fracture Condylar Closed Clinic Charge","code_information":[{"code":"14024576","type":"CDM"},{"code":"510","type":"RC"},{"code":"24576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":253,"maximum":687,"gross_charge":723,"discounted_cash":723,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":687},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":412}]}]},{"description":"96416 Chemo Admin, Iv Infusion, Initiation W/ Pump Charge","code_information":[{"code":"14596416","type":"CDM"},{"code":"335","type":"RC"},{"code":"96416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":679,"gross_charge":715,"discounted_cash":715,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":679},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":408}]}]},{"description":"97605 Negative Pressure Wound Therapy, Total Wound(s) Surface Area < Or = To 50 Square Centimeters","code_information":[{"code":"11097605","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":677,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":677},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":406}]}]},{"description":"Closed Trtmt Of Radial & Ulnar Shaft Fxs; W/o Manipulation Charge","code_information":[{"code":"20025560","type":"CDM"},{"code":"521","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250,"maximum":677,"gross_charge":713,"discounted_cash":713,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":677},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":406}]}]},{"description":"Closed Trtmt Of Metacarpophalangeal Dislocation, Single, W/manipulation; W/o Anesthesia Tech Chg","code_information":[{"code":"20026700","type":"CDM"},{"code":"521","type":"RC"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":675,"gross_charge":710,"discounted_cash":710,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":405}]}]},{"description":"Treat Radius Fracture Tech Chg","code_information":[{"code":"20024650","type":"CDM"},{"code":"521","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":675,"gross_charge":710,"discounted_cash":710,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":405}]}]},{"description":"Champion Slingshot 70 Up","code_information":[{"code":"1602075","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":248,"maximum":673,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":658},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":404}]}]},{"description":"Us Retroperitoneal Limited","code_information":[{"code":"38076775","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":672,"gross_charge":707,"discounted_cash":707,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":658},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403}]}]},{"description":"Overdrill Ao, Dia 3.5mm","code_information":[{"code":"1601986","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":671,"gross_charge":706,"discounted_cash":706,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"30905 Control Nosebleed Posterior 1sted Tech","code_information":[{"code":"12530905","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":669,"gross_charge":704,"discounted_cash":704,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":401}]}]},{"description":"Xr Spine Cervical 4 Or 5 Views","code_information":[{"code":"36072050","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":668,"gross_charge":703,"discounted_cash":703,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":401}]}]},{"description":"Treat Metacarpal Fxclinic","code_information":[{"code":"20026605","type":"CDM"},{"code":"521","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":668,"gross_charge":703,"discounted_cash":703,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":401}]}]},{"description":"27786 Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); W/o Manipulation-clinic","code_information":[{"code":"20027786","type":"CDM"},{"code":"521","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":667,"gross_charge":702,"discounted_cash":702,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":653},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":667},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}]},{"description":"24670-closed Treatment Of Ulnar Fx Proximal End W/o Manipulation","code_information":[{"code":"20024670","type":"CDM"},{"code":"521","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":659,"gross_charge":694,"discounted_cash":694,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":659},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":396}]}]},{"description":"27760 Under Fracture And/or Dislocation Procedures On The Leg (Tibia And Fibula) And Ankle Joint","code_information":[{"code":"20027760","type":"CDM"},{"code":"521","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":658,"gross_charge":693,"discounted_cash":693,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":658},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":395}]}]},{"description":"Absorbable Hemostatic Particles (Arista Ah)","code_information":[{"code":"1601734","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601734","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":656,"gross_charge":690,"discounted_cash":690,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":393}]}]},{"description":"5-hiaa, Plasma (Rps) Pspc","code_information":[{"code":"35082542P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":655,"gross_charge":689,"discounted_cash":689,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":393}]}]},{"description":"Exc Mal Lesion T/a/l; 3.1 To 4.0 Cmclinic","code_information":[{"code":"20011604","type":"CDM"},{"code":"521","type":"RC"},{"code":"11604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":654,"gross_charge":688,"discounted_cash":688,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":392}]}]},{"description":"Xr Ribs W/ Pa Chest Bilateral Min 4 Views","code_information":[{"code":"36071111","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":653,"gross_charge":687,"discounted_cash":687,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":653},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":392}]}]},{"description":"Calprotectin, Stool Pspc","code_information":[{"code":"35083993P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":652,"gross_charge":686,"discounted_cash":686,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":652},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":391}]}]},{"description":"Stapler Ils 29mm Curved","code_information":[{"code":"1601852","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601852","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":652,"gross_charge":686,"discounted_cash":686,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":652},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":391}]}]},{"description":"Stapler Ils 33mm Curved","code_information":[{"code":"1601851","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601851","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":652,"gross_charge":686,"discounted_cash":686,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":652},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":391}]}]},{"description":"Photonblade","code_information":[{"code":"1601941","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601941","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":651,"gross_charge":685,"discounted_cash":685,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":390}]}]},{"description":"Closed Trtmt Of Patellar Fx, W/o Manipulation Charge","code_information":[{"code":"14027520","type":"CDM"},{"code":"510","type":"RC"},{"code":"27520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":648,"gross_charge":682,"discounted_cash":682,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":634},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":648},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":389}]}]},{"description":"97606 Neg Press Wound Tx > 50 Cm","code_information":[{"code":"14597606","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":647,"gross_charge":681,"discounted_cash":681,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":647},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":388}]}]},{"description":"Exc Tr-ext B9+marg]4.0 Cm-clinic","code_information":[{"code":"20011406","type":"CDM"},{"code":"521","type":"RC"},{"code":"11406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":647,"gross_charge":681,"discounted_cash":681,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":647},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":388}]}]},{"description":"Uromax Ultra Balloon Kit","code_information":[{"code":"1601479","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601479","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":646,"gross_charge":680,"discounted_cash":680,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":646},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":388}]}]},{"description":"51702 Insert Foley Cath Charge","code_information":[{"code":"13551702","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":645,"gross_charge":679,"discounted_cash":679,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":387}]}]},{"description":"27780 Fracture Fibulax Shaft Clinic Charge","code_information":[{"code":"14027780","type":"CDM"},{"code":"510","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":645,"gross_charge":679,"discounted_cash":679,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":387}]}]},{"description":"Xr Hand 2 Views Bilateral","code_information":[{"code":"36073120BI-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":238,"maximum":645,"gross_charge":679,"discounted_cash":679,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":387}]}]},{"description":"Drill Bit, Ao Dia 2.6mm, Scaled","code_information":[{"code":"1601985","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":645,"gross_charge":679,"discounted_cash":679,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":387}]}]},{"description":"Chas Mag 3","code_information":[{"code":"4020233","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":237,"maximum":644,"gross_charge":678,"discounted_cash":678,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":386}]}]},{"description":"Fosaprepitant 150 Mg Rec [Chas]","code_information":[{"code":"CP17640152376480871","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":641,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":385}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Zoledronic Acid 5 Mg/100 Ml Iv Sol[chas]","code_information":[{"code":"CP17640152376560888","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":639,"gross_charge":673,"discounted_cash":673,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":384}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Inhibin B, Pspc","code_information":[{"code":"35083520IBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":637,"gross_charge":671,"discounted_cash":671,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":382}]}]},{"description":"Xr Femur 1 View Bilateral","code_information":[{"code":"36073551BI-1-","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT","modifier":"36892"}],"standard_charges":[{"setting":"outpatient","modifier_code":["36892"],"minimum":234,"maximum":636,"gross_charge":669,"discounted_cash":669,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381}]}]},{"description":"Closed Trtmt Of Carpal Scaphoid (Navicular) Fx; W/o Manipulation Charge","code_information":[{"code":"20025622","type":"CDM"},{"code":"521","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":635,"gross_charge":668,"discounted_cash":668,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":621},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":635},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381}]}]},{"description":"99283 Emergent Care Level 3 Manual -Tech","code_information":[{"code":"13599283","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":631,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"Xr Spine Thoracic 3 Views","code_information":[{"code":"36072072","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":631,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}]},{"description":"12031 Intmd Rpr S/a/t/ext 2.5 Cm/<-ed Tech","code_information":[{"code":"13512031","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":629,"gross_charge":662,"discounted_cash":662,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377}]}]},{"description":"12032layer Closure Of Wounds Of Scalp, Axillae, Trunk, Extrem(exclude Hands And Feet) 2.6 Cm To 07.5","code_information":[{"code":"20012032","type":"CDM"},{"code":"521","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":629,"gross_charge":662,"discounted_cash":662,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377}]}]},{"description":"Change Of Bladder Tube-tech","code_information":[{"code":"14551705","type":"CDM"},{"code":"761","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":628,"gross_charge":661,"discounted_cash":661,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":615},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":377}]}]},{"description":"Exc, Malig Lesion Incl Margins, Scalp, Neck, Hands, Ft, Genitalia; 2.1 To 3.0 Cm Technical Charge","code_information":[{"code":"20011623","type":"CDM"},{"code":"521","type":"RC"},{"code":"11623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":626,"gross_charge":659,"discounted_cash":659,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":376}]}]},{"description":"97606 Wound Neg Pres 750 Sq Cm","code_information":[{"code":"11097606","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":623,"gross_charge":656,"discounted_cash":656,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":374}]}]},{"description":"10120 Fb Removal; Subq, Simple Ed Tech","code_information":[{"code":"13510120","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":622,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":373}]}]},{"description":"54161-circumcision Age >28 Days-ccc","code_information":[{"code":"20054161","type":"CDM"},{"code":"521","type":"RC"},{"code":"54161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":622,"gross_charge":655,"discounted_cash":655,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":373}]}]},{"description":"Rabies Ig, Im/sc 150iu=1ml","code_information":[{"code":"20090375","type":"CDM"},{"code":"521","type":"RC"},{"code":"90375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":228,"maximum":619,"gross_charge":652,"discounted_cash":652,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":619},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":372}]}]},{"description":"Epinephrine 0.15 Mg Syringe[chas]","code_information":[{"code":"CP17640152376471064","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093598527","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":227,"maximum":618,"gross_charge":650,"discounted_cash":650,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":370}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"26770 Closed Treatment Of Interphalangeal Joint Dislocation -Clinic","code_information":[{"code":"20026770","type":"CDM"},{"code":"521","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":227,"maximum":617,"gross_charge":649,"discounted_cash":649,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":617},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":370}]}]},{"description":"12052 Repair Intermediate F/e/e/n/l&/muc 2.6-5.0 Cm Techfee","code_information":[{"code":"13512052","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":615,"gross_charge":647,"discounted_cash":647,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":615},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":369}]}]},{"description":"Change Cystostomy Tube Sm","code_information":[{"code":"13551705","type":"CDM"},{"code":"450","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":615,"gross_charge":647,"discounted_cash":647,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":615},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":369}]}]},{"description":"64615-chemodenerv Musc Migraine-surg Tech","code_information":[{"code":"12564615","type":"CDM"},{"code":"360","type":"RC"},{"code":"64615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":615,"gross_charge":647,"discounted_cash":647,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":615},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":369}]}]},{"description":"Stimulation Lead Kit","code_information":[{"code":"1601563","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601563","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":612,"gross_charge":644,"discounted_cash":644,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"26600 Fracture Metacarpal (Single) Clinic Charge","code_information":[{"code":"20026600","type":"CDM"},{"code":"521","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":612,"gross_charge":644,"discounted_cash":644,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"Layer Closure Of Wounds Of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.6 Cm To 05.0 Cm Charge","code_information":[{"code":"20012052","type":"CDM"},{"code":"521","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":225,"maximum":611,"gross_charge":643,"discounted_cash":643,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":598},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367}]}]},{"description":"General Health Panel Chas","code_information":[{"code":"35080050","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":608,"gross_charge":640,"discounted_cash":640,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":365}]}]},{"description":"Declot Vascular Device [Chas]","code_information":[{"code":"14536593","type":"CDM"},{"code":"761","type":"RC"},{"code":"36593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":608,"gross_charge":640,"discounted_cash":640,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":365}]}]},{"description":"95990-spin/brain Pump Refil & Main-tech","code_information":[{"code":"14595990","type":"CDM"},{"code":"761","type":"RC"},{"code":"95990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":608,"gross_charge":640,"discounted_cash":640,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":365}]}]},{"description":"Kit Percutaneous Insertion 2.0 Pushlock","code_information":[{"code":"1601909","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601909","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":607,"gross_charge":639,"discounted_cash":639,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":364}]}]},{"description":"Bill Only 4k Score Genpath","code_information":[{"code":"35081539GP","type":"CDM"},{"code":"301","type":"RC"},{"code":"81539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":222,"maximum":603,"gross_charge":635,"discounted_cash":635,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":362}]}]},{"description":"Intmd Prpr N-hf/genit 2.6-7.5clinic","code_information":[{"code":"20012042","type":"CDM"},{"code":"521","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":222,"maximum":603,"gross_charge":635,"discounted_cash":635,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":603},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":362}]}]},{"description":"Us Abi's","code_information":[{"code":"38093922","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":600,"gross_charge":632,"discounted_cash":632,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":360}]}]},{"description":"Glucagon 1 Mg/0.2 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376489757","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065013111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":221,"maximum":600,"gross_charge":632,"discounted_cash":632,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":360}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cmv Dna Detection & Quant Pspc","code_information":[{"code":"35087497P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":599,"gross_charge":630,"discounted_cash":630,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":359}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"36072110","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":595,"gross_charge":626,"discounted_cash":626,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":357}]}]},{"description":"Drill Cannulated","code_information":[{"code":"1601873","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":219,"maximum":594,"gross_charge":625,"discounted_cash":625,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":356}]}]},{"description":"23931 Drainage Of Arm Bursa","code_information":[{"code":"20023931-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"23931","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":218,"maximum":592,"gross_charge":623,"discounted_cash":623,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":355}]}]},{"description":"Screw Bc If, Vented","code_information":[{"code":"1601946","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601946","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":591,"gross_charge":622,"discounted_cash":622,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":355}]}]},{"description":"26720 Treat Finger Fracture Eached Tech","code_information":[{"code":"12526720","type":"CDM"},{"code":"450","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":590,"gross_charge":621,"discounted_cash":621,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":354}]}]},{"description":"Linear Cutter 45mm","code_information":[{"code":"1601534","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601534","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":590,"gross_charge":621,"discounted_cash":621,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":354}]}]},{"description":"90649 Gardasil 9 (Hpv) Vaccine Poc [Chas]","code_information":[{"code":"20090649","type":"CDM"},{"code":"521","type":"RC"},{"code":"90649","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":590,"gross_charge":621,"discounted_cash":621,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":354}]}]},{"description":"11603 Excise, Malign Lesion W/margins, Trunk, Arms, Or Legs; Excised Diam 2.1 To 3.0 Cm  Charge","code_information":[{"code":"20011603","type":"CDM"},{"code":"521","type":"RC"},{"code":"11603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":590,"gross_charge":621,"discounted_cash":621,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":354}]}]},{"description":"31500 Pf Intubation Pro Ed Charge","code_information":[{"code":"13531500","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":589,"gross_charge":620,"discounted_cash":620,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":353}]}]},{"description":"10120 Fb Removal; Subq, Simpleed Tech","code_information":[{"code":"12510120","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":589,"gross_charge":620,"discounted_cash":620,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":353}]}]},{"description":"99387 Preventive Medicine 65+ Years New","code_information":[{"code":"20099387","type":"CDM"},{"code":"521","type":"RC"},{"code":"99387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":589,"gross_charge":620,"discounted_cash":620,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":353}]}]},{"description":"27786 Fracture Distal Fibula Clinic Charge","code_information":[{"code":"14027786","type":"CDM"},{"code":"510","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":587,"gross_charge":618,"discounted_cash":618,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":352}]}]},{"description":"Insert Foley Cath Charge","code_information":[{"code":"10551702","type":"CDM"},{"code":"761","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":586,"gross_charge":617,"discounted_cash":617,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":574},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":352}]}]},{"description":"12051 Intmd Rpr Face/mm 2.5 Cm/<","code_information":[{"code":"13512051-CG","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":214,"maximum":581,"gross_charge":612,"discounted_cash":612,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":349}]}]},{"description":"Xr Foot 2 Views Bilateral","code_information":[{"code":"36073620B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":214,"maximum":581,"gross_charge":612,"discounted_cash":612,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":349}]}]},{"description":"32551 Insertion Of Chest Tube -Ed Pf","code_information":[{"code":"1-20032551|1-99932551","type":"CDM"},{"code":"450","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":213,"maximum":579,"gross_charge":609,"discounted_cash":609,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":347}]}]},{"description":"Multiplex Stain Bioref","code_information":[{"code":"35088344BR","type":"CDM"},{"code":"311","type":"RC"},{"code":"88344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":213,"maximum":578,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":347}]}]},{"description":"25600 Tx Distal Radial Frac Ed Charge","code_information":[{"code":"13525600","type":"CDM"},{"code":"450","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":577,"gross_charge":607,"discounted_cash":607,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":346}]}]},{"description":"11042 Deb Subq Tissue 20 Sq Cm/<ed Tech","code_information":[{"code":"12511042","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":577,"gross_charge":607,"discounted_cash":607,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":346}]}]},{"description":"Us Fetal Biophysical Profile","code_information":[{"code":"38076819","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":577,"gross_charge":607,"discounted_cash":607,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":346}]}]},{"description":"10160-puncture Drainage Of Lesion-ed Tech","code_information":[{"code":"13510160","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":576,"gross_charge":606,"discounted_cash":606,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":345}]}]},{"description":"Vitamin K1 Pspc","code_information":[{"code":"35084597P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":575,"gross_charge":605,"discounted_cash":605,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":563},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":345}]}]},{"description":"Remove Fbclinic","code_information":[{"code":"20010121","type":"CDM"},{"code":"521","type":"RC"},{"code":"10121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":211,"maximum":572,"gross_charge":602,"discounted_cash":602,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":572},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":343}]}]},{"description":"28190-removal Of Foot Foreign Body","code_information":[{"code":"14028190","type":"CDM"},{"code":"510","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":571,"gross_charge":601,"discounted_cash":601,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":571},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343}]}]},{"description":"26055 Tendon Sheath Incision Finger","code_information":[{"code":"14026055","type":"CDM"},{"code":"510","type":"RC"},{"code":"26055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":570,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Closed Reduction Of Radial Head Or Neck Fx W/ Manipulation","code_information":[{"code":"14024650","type":"CDM"},{"code":"510","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":570,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Closed Tx Radial Shaft Fracture W/o Manipulation","code_information":[{"code":"20025500","type":"CDM"},{"code":"521","type":"RC"},{"code":"25500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":570,"gross_charge":600,"discounted_cash":600,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"Dexmedetomidine 4 Mcg/ml- Nacl 0.9% 20 Ml [Chas]","code_information":[{"code":"CP17640152376465621","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409166020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":209,"maximum":568,"gross_charge":598,"discounted_cash":598,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":341}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"67700 Blepharotomy, Drainage Of Abscess, Eyelid-clinic","code_information":[{"code":"20067700","type":"CDM"},{"code":"521","type":"RC"},{"code":"67700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":567,"gross_charge":597,"discounted_cash":597,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":340}]}]},{"description":"Respiratory Virus, Na Pspc","code_information":[{"code":"35087633P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":566,"gross_charge":596,"discounted_cash":596,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":340}]}]},{"description":"Xr Ankle 2 Views Bilateral","code_information":[{"code":"36073600B-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":209,"maximum":566,"gross_charge":596,"discounted_cash":596,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":340}]}]},{"description":"Excise, Malign Lesion W/margins, Face, Ears, Eyelids, Nose, Lips; Excised Diam 1.1 To 2.0 Cm  Charge","code_information":[{"code":"20011642","type":"CDM"},{"code":"521","type":"RC"},{"code":"11642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":565,"gross_charge":595,"discounted_cash":595,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":553},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":339}]}]},{"description":"26770 Treat Finger Dislocationed Tech","code_information":[{"code":"12526770","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":208,"maximum":564,"gross_charge":594,"discounted_cash":594,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":339}]}]},{"description":"Xr Spine Entire 4-5 Views","code_information":[{"code":"36072083","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207,"maximum":562,"gross_charge":592,"discounted_cash":592,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":337}]}]},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"14042820","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207,"maximum":562,"gross_charge":592,"discounted_cash":592,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":337}]}]},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"CP17640152543592509","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207,"maximum":562,"gross_charge":592,"discounted_cash":592,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":337}]}]},{"description":"12016-rpr Fe/e/en/l/m 12.6-20-er Tech","code_information":[{"code":"13512016","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":560,"gross_charge":589,"discounted_cash":589,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"12035- Intmd Rpr S/a/t/ext 12.6-20 -Er Tech","code_information":[{"code":"13512035","type":"CDM"},{"code":"450","type":"RC"},{"code":"12035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":560,"gross_charge":589,"discounted_cash":589,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Xr Hips Bil W/ Pelvis 2 Views","code_information":[{"code":"36073521","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":558,"gross_charge":587,"discounted_cash":587,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335}]}]},{"description":"28190 Removal Of Foreign Body, Foot; Subcutaneous-clinic","code_information":[{"code":"20028190","type":"CDM"},{"code":"521","type":"RC"},{"code":"28190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":558,"gross_charge":587,"discounted_cash":587,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335}]}]},{"description":"20552 Inj Trigger Point 1/2 Muscl- Ed Tech","code_information":[{"code":"12520552","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":557,"gross_charge":586,"discounted_cash":586,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334}]}]},{"description":"11602 Excise, Malign Lesion W/margins, Trunk, Arms, Or Legs; Excised Diam 1.1 To 2.0 Cm  Charge","code_information":[{"code":"20011602","type":"CDM"},{"code":"521","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":556,"gross_charge":585,"discounted_cash":585,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333}]}]},{"description":"Us Echo Color Flow Doppler","code_information":[{"code":"38093325","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":554,"gross_charge":583,"discounted_cash":583,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":332}]}]},{"description":"Xr Spine Lumbosacral 2 Or 3 Views","code_information":[{"code":"36072100","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":554,"gross_charge":583,"discounted_cash":583,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":332}]}]},{"description":"43762rplc Gtube No Revj Trc -Tech","code_information":[{"code":"10543762","type":"CDM"},{"code":"110","type":"RC"},{"code":"43762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":553,"gross_charge":582,"discounted_cash":582,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":553},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":332}]}]},{"description":"Bd Bone Density Dexa Study","code_information":[{"code":"36077080","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":553,"gross_charge":582,"discounted_cash":582,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":553},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":332}]}]},{"description":"90710 Proquad (Mmrv) Live [Chas]","code_information":[{"code":"20090710","type":"CDM"},{"code":"521","type":"RC"},{"code":"90710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204,"maximum":553,"gross_charge":582,"discounted_cash":582,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":553},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":332}]}]},{"description":"Chas Cardiolite","code_information":[{"code":"370A9500","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":552,"gross_charge":581,"discounted_cash":581,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":331}]}]},{"description":"25530 Closed Treatment Of Ulnar Shaft Fracture; Without Manipulation-clinic","code_information":[{"code":"20025530","type":"CDM"},{"code":"521","type":"RC"},{"code":"25530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":551,"gross_charge":580,"discounted_cash":580,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":331}]}]},{"description":"Azacitidine 100 Mg Rec[chas]","code_information":[{"code":"CP17640152376449316","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":203,"maximum":551,"gross_charge":580,"discounted_cash":580,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":331}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Human Anti-mouse Ab Pspc","code_information":[{"code":"35083520P","type":"CDM"},{"code":"302","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":549,"gross_charge":578,"discounted_cash":578,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":549},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":329}]}]},{"description":"67938 Removal Of Embedded Foreign Body Eyelid-clinic","code_information":[{"code":"20067938","type":"CDM"},{"code":"521","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":549,"gross_charge":578,"discounted_cash":578,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":549},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":329}]}]},{"description":"Inj, Anesth Agent Or Steroid, Transforaminal Epidural; Lumbar Or Sacral, Each Additional Level","code_information":[{"code":"12564484","type":"CDM"},{"code":"360","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":201,"maximum":545,"gross_charge":574,"discounted_cash":574,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":327}]}]},{"description":"Xr Spine Entire 2-3 Views","code_information":[{"code":"36072082","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":201,"maximum":545,"gross_charge":574,"discounted_cash":574,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":545},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":327}]}]},{"description":"Bit Drill","code_information":[{"code":"1601605","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601605","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":543,"gross_charge":572,"discounted_cash":572,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}]},{"description":"Borrelia Pspc","code_information":[{"code":"35087801P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":542,"gross_charge":571,"discounted_cash":571,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"Application Of Paste Boot","code_information":[{"code":"11029580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":542,"gross_charge":571,"discounted_cash":571,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"99397 Preventive Medicine 65+ Years Established","code_information":[{"code":"20099397-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99397","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":200,"maximum":542,"gross_charge":571,"discounted_cash":571,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"Bronchoscope Bflex 5.0 Single-use","code_information":[{"code":"1602012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":540,"gross_charge":568,"discounted_cash":568,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324}]}]},{"description":"12051 Intermediate Repair Up To 2.5 Cm Face Clinic Charge","code_information":[{"code":"20012051","type":"CDM"},{"code":"521","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":538,"gross_charge":566,"discounted_cash":566,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":323}]}]},{"description":"Initial new patient preventative medicine evaluation (40-64 years)","code_information":[{"code":"20099386","type":"CDM"},{"code":"521","type":"RC"},{"code":"99386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":198,"maximum":537,"gross_charge":565,"discounted_cash":565,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":322}]}]},{"description":"62369 Electronic Analysis Of Programmable, Implanted Pump For Intrathecal Or Epidural Drug Infusion","code_information":[{"code":"14562369","type":"CDM"},{"code":"761","type":"RC"},{"code":"62369","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":535,"gross_charge":563,"discounted_cash":563,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":321}]}]},{"description":"Us Ob Limited (Afi)","code_information":[{"code":"38076815","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":534,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":320}]}]},{"description":"Xr Ribs 2 Views Left","code_information":[{"code":"36071100LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":534,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":320}]}]},{"description":"Xr Ribs 2 Views Right","code_information":[{"code":"36071100RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":534,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":320}]}]},{"description":"Pack Acl","code_information":[{"code":"1601842","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601842","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":197,"maximum":534,"gross_charge":562,"discounted_cash":562,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":320}]}]},{"description":"Excision, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;1.1-2.0 Cm  Technical Charge","code_information":[{"code":"20011622","type":"CDM"},{"code":"521","type":"RC"},{"code":"11622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":533,"gross_charge":561,"discounted_cash":561,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":320}]}]},{"description":"90651 (Hpv 9)  Human Papilloma Vaccine [Chas]","code_information":[{"code":"20090651","type":"CDM"},{"code":"521","type":"RC"},{"code":"90651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":532,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":319}]}]},{"description":"11750 Excise Of Nail & Matrix, Part. Or Complete, For Permanent Removal Charge","code_information":[{"code":"20011750","type":"CDM"},{"code":"521","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":532,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":319}]}]},{"description":"Rt Overnight Oximetry","code_information":[{"code":"30094762","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":531,"gross_charge":559,"discounted_cash":559,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":319}]}]},{"description":"Hla B27 Pspc","code_information":[{"code":"35081374P","type":"CDM"},{"code":"302","type":"RC"},{"code":"81374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":527,"gross_charge":555,"discounted_cash":555,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Bard Guidewire Peg System","code_information":[{"code":"1601385","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601385","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":527,"gross_charge":555,"discounted_cash":555,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Lyme Disease (Borrelia Sp) By Pcr (Pspc)","code_information":[{"code":"35087476P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":526,"gross_charge":554,"discounted_cash":554,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Xr Femur 2 Views Bilateral","code_information":[{"code":"36073552BI-1-","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"36892"}],"standard_charges":[{"setting":"outpatient","modifier_code":["36892"],"minimum":194,"maximum":526,"gross_charge":554,"discounted_cash":554,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"Xr Finger Bilateral","code_information":[{"code":"36073140BI-50","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":194,"maximum":526,"gross_charge":554,"discounted_cash":554,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316}]}]},{"description":"M0243- Intrav Infus Casirivimab/imdevimab-tech","code_information":[{"code":"135M0243","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"M0243 Iv Infuse Casirivimab/imdevimab (Includes Infusion And Post Administration Monitoring","code_information":[{"code":"145M0239","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"M0243-intrav Infus Casirivimab/imdevimab-tech","code_information":[{"code":"145M0243","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Xr Facial Bones Minimum 3 Views","code_information":[{"code":"36070150","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Xr Ribs Min 3 Views Left W/ Pa Chest","code_information":[{"code":"36071101LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Xr Ribs Min 3 Views Right W/ Pa Chest","code_information":[{"code":"36071101RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"12031 Intmd Rpr S/a/t/ext 2.5 Cm/<-ccc","code_information":[{"code":"20012031","type":"CDM"},{"code":"521","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":525,"gross_charge":553,"discounted_cash":553,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Application Of Skin Substitute Graft To Trunk, Arms, Legs, T","code_information":[{"code":"10515271","type":"CDM"},{"code":"110","type":"RC"},{"code":"15271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":523,"gross_charge":551,"discounted_cash":551,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":314}]}]},{"description":"Cii Procise Xp","code_information":[{"code":"1600226","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":523,"gross_charge":551,"discounted_cash":551,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":314}]}]},{"description":"11730 Nail Avulsion Ed Tech","code_information":[{"code":"13511730","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":522,"gross_charge":549,"discounted_cash":549,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":313}]}]},{"description":"Iv Sedation Charge","code_information":[{"code":"130004","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP130004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":522,"gross_charge":549,"discounted_cash":549,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":313}]}]},{"description":"51703 Ins Blddr Cath Comlx Ed Tech","code_information":[{"code":"13551703","type":"CDM"},{"code":"450","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":521,"gross_charge":548,"discounted_cash":548,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Chas Maa Isotope","code_information":[{"code":"370A9540","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":521,"gross_charge":548,"discounted_cash":548,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Xr Abdomen 2 Views","code_information":[{"code":"36074019","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Xr Skull Complete","code_information":[{"code":"36070260","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider 25 Deg Left","code_information":[{"code":"1602041","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider 25 Deg Right","code_information":[{"code":"1602040","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider 45 Deg Left","code_information":[{"code":"1602045","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider 45 Deg Right","code_information":[{"code":"1602039","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider 60 Deg Straight","code_information":[{"code":"1602044","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider Crescent Large","code_information":[{"code":"1602042","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Needle Slider Crescent Medium","code_information":[{"code":"1602043","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":191,"maximum":520,"gross_charge":547,"discounted_cash":547,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":312}]}]},{"description":"Call In Fee For Sample Referrals, Arc","code_information":[{"code":"350ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"CP350ARC","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":514,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":308}]}]},{"description":"Measles, Mumps, Rubella, And Varicella Vaccine (Mmrv), Live, For Subcutaneous Use Poc","code_information":[{"code":"20090710-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90710","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":189,"maximum":514,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":308}]}]},{"description":"12041 Repair; Intermediate N/h/f/2.5 Cm Or Less-clinic","code_information":[{"code":"20012041","type":"CDM"},{"code":"521","type":"RC"},{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":514,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":514},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":308}]}]},{"description":"17004 Destruction  Premalignant Lesions   15 Or More Lesions","code_information":[{"code":"20017004","type":"CDM"},{"code":"521","type":"RC"},{"code":"17004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":513,"gross_charge":540,"discounted_cash":540,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":308}]}]},{"description":"Calreticulin Exon 9 Mutation Pcr Pspc","code_information":[{"code":"35081219P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"Mpl Codon 515 Mutation By Pyro Quant Pspc","code_information":[{"code":"35081402P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"12005-rpr S/n/a/gen/trk 12.6-20.0cmed Tech","code_information":[{"code":"13512005","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"12006-rpr S/n/a/gen/trk20.1-30.0cmed Tech","code_information":[{"code":"12512006","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"Us Ob Follow-up/repeat","code_information":[{"code":"38076816","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"Xr Hip Min 4 Views Lt W/ Pelvis","code_information":[{"code":"36073503LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"Xr Hip Min 4 Views Rt W/ Pelvis","code_information":[{"code":"36073503RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":512,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":307}]}]},{"description":"Room/bed: Non-skilled","code_information":[{"code":"110000","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP110000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":510,"gross_charge":537,"discounted_cash":537,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":306}]}]},{"description":"Mammography of both breasts","code_information":[{"code":"36077066","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":510,"gross_charge":537,"discounted_cash":537,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":306}]}]},{"description":"Xr Mandible Complete Minimum 4 Views","code_information":[{"code":"36070110","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":508,"gross_charge":535,"discounted_cash":535,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305}]}]},{"description":"Treat Metatarsal Fractureclinic Charge","code_information":[{"code":"20028470","type":"CDM"},{"code":"521","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":507,"gross_charge":534,"discounted_cash":534,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304}]}]},{"description":"Iv Meds First Hrchas Op","code_information":[{"code":"14596365","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":505,"gross_charge":532,"discounted_cash":532,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":303}]}]},{"description":"Rbc Cpd As1 500 Lr","code_information":[{"code":"350P9016","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":504,"gross_charge":531,"discounted_cash":531,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":494},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":303}]}]},{"description":"Thyroid Stimulating Immunoglobulin Pspc","code_information":[{"code":"35084445P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":504,"gross_charge":530,"discounted_cash":530,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":302}]}]},{"description":"Stapler Multifire 4.8 Mm","code_information":[{"code":"1600858","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600858","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":504,"gross_charge":530,"discounted_cash":530,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":302}]}]},{"description":"Treat Metatarsal Fracture","code_information":[{"code":"20028475","type":"CDM"},{"code":"521","type":"RC"},{"code":"28475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":186,"maximum":504,"gross_charge":530,"discounted_cash":530,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":302}]}]},{"description":"Er/aspiration/inject Major Joint","code_information":[{"code":"13520610","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"20605 Drain/inj Joint/bursa W/o Us-tech","code_information":[{"code":"12520605","type":"CDM"},{"code":"360","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"64400-n Block Inj Trigeminal-tech","code_information":[{"code":"12564400","type":"CDM"},{"code":"360","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Drain/inj Joint/bursa W/o Us-tech","code_information":[{"code":"12520610","type":"CDM"},{"code":"360","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Inject Trigger Point 3/]","code_information":[{"code":"12520553","type":"CDM"},{"code":"360","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"N Block Inj Occipital","code_information":[{"code":"12564405","type":"CDM"},{"code":"360","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Us Pelvic Limited","code_information":[{"code":"38076857","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Screw Val, Ti","code_information":[{"code":"1602002","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Universa C-taper Adapter Sleeve","code_information":[{"code":"1601747","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601747","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":502,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":301}]}]},{"description":"Cancellous Bone Screw 6.5 45mm","code_information":[{"code":"1601679","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601679","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":501,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":300}]}]},{"description":"Nh-nursing Facility Care-new Problem 35 Min","code_information":[{"code":"20099310-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99310","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":184,"maximum":500,"gross_charge":526,"discounted_cash":526,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":300}]}]},{"description":"Procollagen Type I Intact N-t Propeptide Pspc","code_information":[{"code":"35083519P","type":"CDM"},{"code":"302","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":497,"gross_charge":523,"discounted_cash":523,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":298}]}]},{"description":"96365 Iv Meds First Hred Tech [Chas]","code_information":[{"code":"13596365","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":496,"gross_charge":522,"discounted_cash":522,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":298}]}]},{"description":"Office/op Established  Visit Level 5 99215","code_information":[{"code":"20099215","type":"CDM"},{"code":"521","type":"RC"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":496,"gross_charge":522,"discounted_cash":522,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":298}]}]},{"description":"Excise, Malign Lesion W/margins, Face, Ears, Eyelids, Nose, Lips; Excised Diam 0.6 To 1.0 Cm  Charge","code_information":[{"code":"20011641","type":"CDM"},{"code":"521","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":496,"gross_charge":522,"discounted_cash":522,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":298}]}]},{"description":"46083 Incise External Hemorrhoided Tech","code_information":[{"code":"12546083","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":495,"gross_charge":521,"discounted_cash":521,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297}]}]},{"description":"Hepatitis C Virus  Fibrosure (Lch) Pspc","code_information":[{"code":"35081596P","type":"CDM"},{"code":"302","type":"RC"},{"code":"81596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":492,"gross_charge":518,"discounted_cash":518,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}]},{"description":"12015 Rpr Smpl F/e/e/n/l/m 7.6-12.5cmed Tech","code_information":[{"code":"12512015","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":492,"gross_charge":518,"discounted_cash":518,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}]},{"description":"Factor V Leiden Mutation (Rps) Pspc","code_information":[{"code":"35081241P","type":"CDM"},{"code":"305","type":"RC"},{"code":"81241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":491,"gross_charge":517,"discounted_cash":517,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}]},{"description":"Prothrombin Factor Ii Dna (Rps) Pspc","code_information":[{"code":"35081240RPS","type":"CDM"},{"code":"305","type":"RC"},{"code":"81240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":491,"gross_charge":517,"discounted_cash":517,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}]},{"description":"Xr Pelvis 1 Or 2 Views","code_information":[{"code":"36072170","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":491,"gross_charge":517,"discounted_cash":517,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}]},{"description":"Bupivacaine Liposome 1.3%  Sdpf [Chas]","code_information":[{"code":"CP17640152376458313","type":"CDM"},{"code":"250","type":"RC"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":181,"maximum":491,"gross_charge":517,"discounted_cash":517,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":491},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":295}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"99396 Preventive Medicine 40-64 Years Established","code_information":[{"code":"20099396-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99396","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":181,"maximum":490,"gross_charge":516,"discounted_cash":516,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":294}]}]},{"description":"10060 I&d Abscess Simple/single","code_information":[{"code":"13510060","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":489,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":294}]}]},{"description":"Us Breast Left Limited","code_information":[{"code":"38076642LT-LT","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":180,"maximum":489,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":294}]}]},{"description":"Us Breast Right Limited","code_information":[{"code":"38076642RT-RT","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":180,"maximum":489,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":294}]}]},{"description":"Xr Pelvis Complete Minimum 3 Views","code_information":[{"code":"36072190","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":487,"gross_charge":513,"discounted_cash":513,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":292}]}]},{"description":"Needle Scorpion Multifire","code_information":[{"code":"1601908","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601908","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":487,"gross_charge":513,"discounted_cash":513,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":292}]}]},{"description":"Initial new patient preventative medicine evaluation (18-39 years)","code_information":[{"code":"20099385-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99385","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":180,"maximum":487,"gross_charge":513,"discounted_cash":513,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":292}]}]},{"description":"11621 Exc S/n/h/f/g Mal+mrg 0.6-1cm-clinic","code_information":[{"code":"20011621","type":"CDM"},{"code":"521","type":"RC"},{"code":"11621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":487,"gross_charge":513,"discounted_cash":513,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":292}]}]},{"description":"Appl. Of Long Leg Cast (Thigh To Toes)","code_information":[{"code":"13529345","type":"CDM"},{"code":"450","type":"RC"},{"code":"29345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":485,"gross_charge":510,"discounted_cash":510,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":291}]}]},{"description":"29580 Application Of Unna Boot","code_information":[{"code":"14529580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":482,"gross_charge":507,"discounted_cash":507,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":482},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":289}]}]},{"description":"Screw Quickfix","code_information":[{"code":"1601757","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601757","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":481,"gross_charge":506,"discounted_cash":506,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":288}]}]},{"description":"12001-rpr Smpl Sclp/nck/trnk/ex-ed Tech","code_information":[{"code":"13512001","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":480,"gross_charge":505,"discounted_cash":505,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":288}]}]},{"description":"Mesh Parietex Progrip Left Side","code_information":[{"code":"1601905","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601905","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":480,"gross_charge":505,"discounted_cash":505,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":288}]}]},{"description":"Mesh Parietex Progrip Right Side 5.5 X 3.5","code_information":[{"code":"1601770","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601770","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":480,"gross_charge":505,"discounted_cash":505,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":288}]}]},{"description":"Articular Fracture, Involving Metacarpophalangeal Or Interphalangeal Jointclosed Treatment Of Wo","code_information":[{"code":"20026740","type":"CDM"},{"code":"521","type":"RC"},{"code":"26740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":177,"maximum":480,"gross_charge":505,"discounted_cash":505,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":288}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"20045385","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":479,"gross_charge":504,"discounted_cash":504,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":287}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"14045385","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":479,"gross_charge":504,"discounted_cash":504,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":287}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"CP17640152543602321","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":479,"gross_charge":504,"discounted_cash":504,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":287}]}]},{"description":"Glucagon Human 1 Mg Kit[chas]","code_information":[{"code":"CP17640152376484308","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323059303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":176,"maximum":479,"gross_charge":504,"discounted_cash":504,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":287}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"11601 Excision, Malignant Lesion Trunk .6 To 1.0 Cmclinic","code_information":[{"code":"20011601","type":"CDM"},{"code":"521","type":"RC"},{"code":"11601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":478,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":287}]}]},{"description":"29405 Apply Short Leg Casted Tech","code_information":[{"code":"12529405","type":"CDM"},{"code":"450","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":477,"gross_charge":502,"discounted_cash":502,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":286}]}]},{"description":"11983 Removal, With Reinsertion, Non-biodegradable Drug Delivery-clinic","code_information":[{"code":"20011983","type":"CDM"},{"code":"521","type":"RC"},{"code":"11983","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176,"maximum":477,"gross_charge":502,"discounted_cash":502,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":286}]}]},{"description":"Hydroxychloroquine, Blood (Rps) Pspc","code_information":[{"code":"35080220RPS","type":"CDM"},{"code":"301","type":"RC"},{"code":"80220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":473,"gross_charge":498,"discounted_cash":498,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":284}]}]},{"description":"Iv Hydration  1st Hour Tech Chg","code_information":[{"code":"14596360","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":473,"gross_charge":498,"discounted_cash":498,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":284}]}]},{"description":"Reload For F Lex 45mm Stapler Blue","code_information":[{"code":"1601828","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":471,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":283}]}]},{"description":"Surefire Scorpion Needle","code_information":[{"code":"1601693","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601693","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":470,"gross_charge":495,"discounted_cash":495,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":282}]}]},{"description":"20520-removal Of Foreign Body","code_information":[{"code":"20020520","type":"CDM"},{"code":"521","type":"RC"},{"code":"20520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":470,"gross_charge":495,"discounted_cash":495,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":282}]}]},{"description":"Hepatitis B Virus Dna, Quant Pspc","code_information":[{"code":"35087517PS","type":"CDM"},{"code":"301","type":"RC"},{"code":"87517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":469,"gross_charge":494,"discounted_cash":494,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":282}]}]},{"description":"51700-irrigation Of Bladder-tech","code_information":[{"code":"14551700","type":"CDM"},{"code":"761","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":469,"gross_charge":494,"discounted_cash":494,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":282}]}]},{"description":"Rhig","code_information":[{"code":"350006","type":"CDM"},{"code":"250","type":"RC"},{"code":"90384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Xr Bone Survey Infant","code_information":[{"code":"36077076","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Hand 2 Views Left","code_information":[{"code":"36073120LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Hand 2 Views Right","code_information":[{"code":"36073120RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Joint Survey Single View","code_information":[{"code":"36077077","type":"CDM"},{"code":"320","type":"RC"},{"code":"77077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Knee Complete Left","code_information":[{"code":"36073564LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Knee Complete Right","code_information":[{"code":"36073564RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Sacroiliac Joints","code_information":[{"code":"36072202","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Scapula Left","code_information":[{"code":"36073010L-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Scapula Right","code_information":[{"code":"36073010R-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Skull < 4 Views","code_information":[{"code":"36070250","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"Xr Spine Thoracic 2 Views","code_information":[{"code":"36072070","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":467,"gross_charge":492,"discounted_cash":492,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"32554 Thoracentesis W/o Guidanc Clinic Charge","code_information":[{"code":"20032554","type":"CDM"},{"code":"521","type":"RC"},{"code":"32554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":466,"gross_charge":491,"discounted_cash":491,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280}]}]},{"description":"96360 Iv Hydration First Hred Tech","code_information":[{"code":"13596360","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":465,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":279}]}]},{"description":"59025 Fetal Non-stress Test","code_information":[{"code":"12059025","type":"CDM"},{"code":"720","type":"RC"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":465,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":279}]}]},{"description":"Xr Shoulder Complete Left","code_information":[{"code":"36073030L-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":171,"maximum":465,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":279}]}]},{"description":"Xr Shoulder Complete Right","code_information":[{"code":"36073030R-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":171,"maximum":465,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":279}]}]},{"description":"Remove Lesion, Face/lid/ear/nose/lip 2.1 To 3.0 Cm Charge","code_information":[{"code":"20011443","type":"CDM"},{"code":"521","type":"RC"},{"code":"11443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":465,"gross_charge":489,"discounted_cash":489,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":279}]}]},{"description":"Interleukin 2 Receptor (Cd25), Soluble (Rps) Pspc","code_information":[{"code":"35083520PSPC","type":"CDM"},{"code":"302","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":463,"gross_charge":487,"discounted_cash":487,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":278}]}]},{"description":"24640 -Closed Tx Radial Head Sublux Child/ Nursemaid Elbow W/ Manipulation Er Tech","code_information":[{"code":"13524640","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":462,"gross_charge":486,"discounted_cash":486,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":277}]}]},{"description":"27562 Closed Tx Patellar Dislocation W/anesthesia Techfee","code_information":[{"code":"13527562","type":"CDM"},{"code":"450","type":"RC"},{"code":"27562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":462,"gross_charge":486,"discounted_cash":486,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":277}]}]},{"description":"Closed Treatment Of Clavicular Fracture; Without Manipulatio","code_information":[{"code":"13523500","type":"CDM"},{"code":"450","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":462,"gross_charge":486,"discounted_cash":486,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":277}]}]},{"description":"Reload Ar Xtra-thin/vascular 45mm","code_information":[{"code":"1601831","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601831","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":170,"maximum":461,"gross_charge":485,"discounted_cash":485,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":276}]}]},{"description":"Bio-suturetak Disp Kit W/metal Spear","code_information":[{"code":"1601694","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601694","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":460,"gross_charge":484,"discounted_cash":484,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":276}]}]},{"description":"Screw Locking Screw Slf-tpng W/ Stardriv Recess 3.5mm","code_information":[{"code":"1601920","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":460,"gross_charge":484,"discounted_cash":484,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":276}]}]},{"description":"Er Reduce Shoulder Disloc Charge","code_information":[{"code":"13523650","type":"CDM"},{"code":"450","type":"RC"},{"code":"23650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":455,"gross_charge":479,"discounted_cash":479,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":273}]}]},{"description":"23500 Closed Trtmt Of Clavicular Fx; W/o Manipulation Charge","code_information":[{"code":"20023500","type":"CDM"},{"code":"521","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":455,"gross_charge":479,"discounted_cash":479,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":273}]}]},{"description":"Treat Finger Fracture Eachclinic","code_information":[{"code":"20026720","type":"CDM"},{"code":"521","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":168,"maximum":455,"gross_charge":479,"discounted_cash":479,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":273}]}]},{"description":"Methylene Blue 1% Sdv10 Ml[chas]","code_information":[{"code":"CP17640152376519184","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288014701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":168,"maximum":455,"gross_charge":479,"discounted_cash":479,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":455},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":273}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"26775 Cltx Iphal Jt Dislc W/manj Req Anes Techfee","code_information":[{"code":"13526775","type":"CDM"},{"code":"450","type":"RC"},{"code":"26775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}]},{"description":"43752- Nasal/orogastric W/tube Plmted Tech","code_information":[{"code":"13543752","type":"CDM"},{"code":"450","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}]},{"description":"Applic, Cast; Shoulder To Hand (Long Arm) Tech Chg","code_information":[{"code":"13529065","type":"CDM"},{"code":"450","type":"RC"},{"code":"29065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"36071046","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}]},{"description":"Xr Nasal Bones Minimum 3 Views","code_information":[{"code":"36070160","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}]},{"description":"Bcg Live 50 Mg Vial [Chas]","code_information":[{"code":"CP17640152376444079","type":"CDM"},{"code":"250","type":"RC"},{"code":"00052060202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":167,"maximum":453,"gross_charge":477,"discounted_cash":477,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":272}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nitinol Basket 2.4frx115c","code_information":[{"code":"1600661","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600661","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":452,"gross_charge":476,"discounted_cash":476,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":271}]}]},{"description":"Peg Kit Safety, Pull 20fr","code_information":[{"code":"1601970","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601970","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":452,"gross_charge":476,"discounted_cash":476,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":271}]}]},{"description":"Reliatack Reload Reltack 10r","code_information":[{"code":"1601705","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601705","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":452,"gross_charge":476,"discounted_cash":476,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":271}]}]},{"description":"Screw Bone T10 Full Thread","code_information":[{"code":"1601984","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":167,"maximum":452,"gross_charge":476,"discounted_cash":476,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":271}]}]},{"description":"Exc Tr-ext 59+marg 3.14-4cm","code_information":[{"code":"20011404","type":"CDM"},{"code":"521","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":451,"gross_charge":475,"discounted_cash":475,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":271}]}]},{"description":"Xr Spine Cervical 2 Or 3 Views","code_information":[{"code":"36072040","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":450,"gross_charge":474,"discounted_cash":474,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":270}]}]},{"description":"Dexamethasone-tobramycin Opth 0.1%-0.3% Oint3.5 Gm[chas]","code_information":[{"code":"CP17640152376469469","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":166,"maximum":450,"gross_charge":474,"discounted_cash":474,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":270}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"26720 Treat Finger Fracture Eachclinic","code_information":[{"code":"14026720","type":"CDM"},{"code":"510","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":449,"gross_charge":473,"discounted_cash":473,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":449},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":270}]}]},{"description":"Chas Dtpapentatae Isotope","code_information":[{"code":"370A9567","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":447,"gross_charge":470,"discounted_cash":470,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":268}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"6 Minute Walk Test","code_information":[{"code":"30094620","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165,"maximum":447,"gross_charge":470,"discounted_cash":470,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":268}]}]},{"description":"Epinephrine 0.3 Mg Syringe[chas]","code_information":[{"code":"CP17640152376473609","type":"CDM"},{"code":"250","type":"RC"},{"code":"00115169449","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":165,"maximum":447,"gross_charge":470,"discounted_cash":470,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":268}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Chemo Iv Push","code_information":[{"code":"14596409","type":"CDM"},{"code":"331","type":"RC"},{"code":"96409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":445,"gross_charge":468,"discounted_cash":468,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":267}]}]},{"description":"Xr Knee 3 Views Left","code_information":[{"code":"36073562LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":164,"maximum":445,"gross_charge":468,"discounted_cash":468,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":267}]}]},{"description":"Xr Knee 3 Views Right","code_information":[{"code":"36073562RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":164,"maximum":445,"gross_charge":468,"discounted_cash":468,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":267}]}]},{"description":"Paracentesis, Abd, W/o Image Guidance Tech Fee","code_information":[{"code":"20049082","type":"CDM"},{"code":"521","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":444,"gross_charge":467,"discounted_cash":467,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266}]}]},{"description":"99395 Preventive Medicine 18-39 Years Established","code_information":[{"code":"20099395","type":"CDM"},{"code":"521","type":"RC"},{"code":"99395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":441,"gross_charge":464,"discounted_cash":464,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":264}]}]},{"description":"Cricothyrotomy Cath Set Melker Emergency C-tccs-350","code_information":[{"code":"1602081","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602081","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":439,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}]},{"description":"Endo Handle Xl 12mm","code_information":[{"code":"1601830","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":439,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}]},{"description":"Multivitamin 10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376510194","type":"CDM"},{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":162,"maximum":439,"gross_charge":462,"discounted_cash":462,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Chas Choletec/mebrofenin","code_information":[{"code":"370A9537","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":438,"gross_charge":461,"discounted_cash":461,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}]},{"description":"99384 Preventive Medicine 12-17 Years New","code_information":[{"code":"20099384-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99384","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":161,"maximum":438,"gross_charge":461,"discounted_cash":461,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}]},{"description":"90677 Pneumococcal 20 Valent Conj [Chas]","code_information":[{"code":"20090677","type":"CDM"},{"code":"636","type":"RC"},{"code":"90677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":438,"gross_charge":461,"discounted_cash":461,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":263}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Rh Ig Full Dose Im","code_information":[{"code":"13590384","type":"CDM"},{"code":"450","type":"RC"},{"code":"90384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":437,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":262}]}]},{"description":"Chas Hepatolite Disofenin","code_information":[{"code":"370A9510","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":437,"gross_charge":460,"discounted_cash":460,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":262}]}]},{"description":"21310 Closed Treatment Nasal Fracture W/o Manipulation Techfee","code_information":[{"code":"13521310","type":"CDM"},{"code":"450","type":"RC"},{"code":"21310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"24530 Closed Treat Humeral Frac W/w/out Intercon Ext W/out Manip","code_information":[{"code":"13524530","type":"CDM"},{"code":"450","type":"RC"},{"code":"24530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"27786 Cltx Dstl Fibular Fx Lat Malls W/o Manj Techfee","code_information":[{"code":"13527786","type":"CDM"},{"code":"450","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Chromogranin A Pspc","code_information":[{"code":"35086316P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Endo Shears 5mm","code_information":[{"code":"1600364","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Knot Pusher/suture Cutter W/ Portal Skid","code_information":[{"code":"1602018","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Mesh Parietex Left","code_information":[{"code":"1601488","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601488","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Mesh Parietex Right","code_information":[{"code":"1601487","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601487","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Minilap Clutch Grasper","code_information":[{"code":"1601931","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":435,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":261}]}]},{"description":"Lacosamine Pspc","code_information":[{"code":"35080339P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"Xr Hand Min 3 Views Left","code_information":[{"code":"36073130LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"Xr Hand Min 3 Views Right","code_information":[{"code":"36073130RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"Purstring 65 Inst","code_information":[{"code":"1601866","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"20099205","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"90620 Bexsero Meningococcal Recomb 2 Dose Im [Chas]","code_information":[{"code":"20090620-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90620","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":160,"maximum":433,"gross_charge":456,"discounted_cash":456,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":260}]}]},{"description":"Hp F5 Gene, Pspc","code_information":[{"code":"35081241HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":431,"gross_charge":454,"discounted_cash":454,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":259}]}]},{"description":"Fx Metatarsal Charge","code_information":[{"code":"13528470","type":"CDM"},{"code":"450","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":431,"gross_charge":454,"discounted_cash":454,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":259}]}]},{"description":"10061 Drain Skin Abscess, Complex/multiple Charge","code_information":[{"code":"20010061","type":"CDM"},{"code":"521","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159,"maximum":431,"gross_charge":454,"discounted_cash":454,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":259}]}]},{"description":"Adl Training Charges","code_information":[{"code":"32097535-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":158,"maximum":429,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":258}]}]},{"description":"Xr Ankle Complete Left","code_information":[{"code":"36073610LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":158,"maximum":429,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":258}]}]},{"description":"Xr Ankle Complete Right","code_information":[{"code":"36073610RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":158,"maximum":429,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":258}]}]},{"description":"Xr Foot Complete Left","code_information":[{"code":"36073630LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":158,"maximum":429,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":258}]}]},{"description":"Xr Foot Complete Right","code_information":[{"code":"36073630RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":158,"maximum":429,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":258}]}]},{"description":"26755-treat Finger Fracture","code_information":[{"code":"13526755","type":"CDM"},{"code":"450","type":"RC"},{"code":"26755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":428,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":257}]}]},{"description":"92950heart/lung Resuscitation Cpr -Tech","code_information":[{"code":"10592950","type":"CDM"},{"code":"110","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":428,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":257}]}]},{"description":"Closed Treatment Of Distal Phalangeal Fracture, Finger/thumb W/o Manipulation","code_information":[{"code":"14026750","type":"CDM"},{"code":"510","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":428,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":257}]}]},{"description":"Xr Acromioclavicular Joints Bilateral","code_information":[{"code":"36073050","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":428,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":257}]}]},{"description":"Xr Sinuses Paranasal Complete","code_information":[{"code":"36070220","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":427,"gross_charge":449,"discounted_cash":449,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":256}]}]},{"description":"Insert Needle Bone Cavity","code_information":[{"code":"13536680","type":"CDM"},{"code":"450","type":"RC"},{"code":"36680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":425,"gross_charge":447,"discounted_cash":447,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":255}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"36077067LT-1-","type":"CDM"},{"code":"401","type":"RC"},{"code":"77067","type":"CPT","modifier":"36892"}],"standard_charges":[{"setting":"outpatient","modifier_code":["36892"],"minimum":156,"maximum":425,"gross_charge":447,"discounted_cash":447,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":255}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"36077067B","type":"CDM"},{"code":"401","type":"RC"},{"code":"77067","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":425,"gross_charge":447,"discounted_cash":447,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":255}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"36077067RT-1-","type":"CDM"},{"code":"401","type":"RC"},{"code":"77067","type":"CPT","modifier":"36892"}],"standard_charges":[{"setting":"outpatient","modifier_code":["36892"],"minimum":156,"maximum":425,"gross_charge":447,"discounted_cash":447,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":255}]}]},{"description":"27560-treat Kneecap Dislocation-ed Tech","code_information":[{"code":"13527560","type":"CDM"},{"code":"450","type":"RC"},{"code":"27560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":424,"gross_charge":446,"discounted_cash":446,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":254}]}]},{"description":"Endo Cath Gold 10 Mm","code_information":[{"code":"1600362","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600362","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":422,"gross_charge":444,"discounted_cash":444,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"27788-treatment Of Ankle Fracture-ed Tech","code_information":[{"code":"13527788","type":"CDM"},{"code":"450","type":"RC"},{"code":"27788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Xr Foot 2 Views Left","code_information":[{"code":"36073620L-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Xr Foot 2 Views Right","code_information":[{"code":"36073620R-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Xr Humerus Min 2 Views Left","code_information":[{"code":"36073060LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Xr Humerus Minimum 2 Views Right","code_information":[{"code":"36073060RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Xr Neck Soft Tissue","code_information":[{"code":"36070360","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":421,"gross_charge":443,"discounted_cash":443,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":253}]}]},{"description":"Hemochromatosis Genetic Panel (Rps) Pspc","code_information":[{"code":"35081256P","type":"CDM"},{"code":"305","type":"RC"},{"code":"81256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":420,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":252}]}]},{"description":"Xr Knee One Or Two Views Left","code_information":[{"code":"36073560LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":155,"maximum":420,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":252}]}]},{"description":"Xr Knee One Or Two Views Right","code_information":[{"code":"36073560RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":155,"maximum":420,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":252}]}]},{"description":"St Speech/hearing Therapychas","code_information":[{"code":"33092507-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":155,"maximum":420,"gross_charge":442,"discounted_cash":442,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":252}]}]},{"description":"Cannula Slotted, 2-0 Knot Pusher/suture Cutter","code_information":[{"code":"1602056","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"Carbofix Locking Shaft Screw 2.5 L=20","code_information":[{"code":"1602146","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602146","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"Carbofix Locking Shaft Screw 2.5 L=16","code_information":[{"code":"1602145","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602145","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"Stent Ureteral Classic 6fr X 26cm","code_information":[{"code":"1602062","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"11423-excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Scalp, N","code_information":[{"code":"20011423","type":"CDM"},{"code":"521","type":"RC"},{"code":"11423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"Excise, Malign Lesion W/margins, Face, Ears, Eyelids, Nose, Lips; Excised Diam 0.5 Cm Or Less Charge","code_information":[{"code":"20011640","type":"CDM"},{"code":"521","type":"RC"},{"code":"11640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":418,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":251}]}]},{"description":"95250-cont Gluc Mntr Phys/qhp Eqp-tech","code_information":[{"code":"17095250","type":"CDM"},{"code":"942","type":"RC"},{"code":"95250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":417,"gross_charge":439,"discounted_cash":439,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":250}]}]},{"description":"29125 Appl Splnt Shrt Arm St","code_information":[{"code":"13529125","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":416,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":250}]}]},{"description":"St Speech Sound Lang Comprehchas","code_information":[{"code":"33092523-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92523","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":153,"maximum":416,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":250}]}]},{"description":"Incise External Hemorrhoid-ed Tech","code_information":[{"code":"13546083","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":415,"gross_charge":437,"discounted_cash":437,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":249}]}]},{"description":"Organic Acid Urine Pspc","code_information":[{"code":"35083918P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":415,"gross_charge":437,"discounted_cash":437,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":249}]}]},{"description":"Xr Tibia/fibula Left","code_information":[{"code":"36073590LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":153,"maximum":415,"gross_charge":437,"discounted_cash":437,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":249}]}]},{"description":"Xr Tibia/fibula Right","code_information":[{"code":"36073590RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":153,"maximum":415,"gross_charge":437,"discounted_cash":437,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":249}]}]},{"description":"Xr Elbow Min 3 Views Left","code_information":[{"code":"36073080LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":152,"maximum":413,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":248}]}]},{"description":"Xr Elbow Min 3 Views Right","code_information":[{"code":"36073080RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":152,"maximum":413,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":248}]}]},{"description":"99383 Preventive Medicine 5-11 Years New","code_information":[{"code":"20099383-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99383","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":152,"maximum":413,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":248}]}]},{"description":"65220 Rm Fb Cornea -Ed Tech","code_information":[{"code":"13565220","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":412,"gross_charge":434,"discounted_cash":434,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":247}]}]},{"description":"Surgicel Snow 2 X 4","code_information":[{"code":"1602029","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":411,"gross_charge":433,"discounted_cash":433,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":247}]}]},{"description":"Coronavirus Pcr (Rps) Pspc","code_information":[{"code":"350U0002","type":"CDM"},{"code":"302","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":151,"maximum":410,"gross_charge":432,"discounted_cash":432,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":246}]}]},{"description":"Stent Urethral 7fr","code_information":[{"code":"1600866","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":407,"gross_charge":428,"discounted_cash":428,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":244}]}]},{"description":"Excision, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Less Than0.5 Cm Technical Charge","code_information":[{"code":"20011620","type":"CDM"},{"code":"521","type":"RC"},{"code":"11620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":406,"gross_charge":427,"discounted_cash":427,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":243}]}]},{"description":"32557-insert Cath Pleura W/image-edtech","code_information":[{"code":"13532557","type":"CDM"},{"code":"450","type":"RC"},{"code":"32557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":405,"gross_charge":426,"discounted_cash":426,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":243}]}]},{"description":"30300 Remove Nasal Fb Hosped Tech","code_information":[{"code":"12530300","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":405,"gross_charge":426,"discounted_cash":426,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":243}]}]},{"description":"Xr Abdomen 1 View","code_information":[{"code":"36074018","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":405,"gross_charge":426,"discounted_cash":426,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":243}]}]},{"description":"Plate Threaded Tack","code_information":[{"code":"1601606","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":405,"gross_charge":426,"discounted_cash":426,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":243}]}]},{"description":"Closed Treatment Of Posterior Malleolus Fracture; Without Ma","code_information":[{"code":"20011600","type":"CDM"},{"code":"521","type":"RC"},{"code":"11600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":404,"gross_charge":425,"discounted_cash":425,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":242}]}]},{"description":"99282- Ed Visit Lvl 2- Sf Dec Making","code_information":[{"code":"13599282","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":403,"gross_charge":424,"discounted_cash":424,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":242}]}]},{"description":"Pneumothorax Set","code_information":[{"code":"1601354","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601354","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":402,"gross_charge":423,"discounted_cash":423,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"10080 Drainage Of Pilonidal Cyst; Simple-clinic","code_information":[{"code":"20010080","type":"CDM"},{"code":"521","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":402,"gross_charge":423,"discounted_cash":423,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis,","code_information":[{"code":"20011760","type":"CDM"},{"code":"521","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":402,"gross_charge":423,"discounted_cash":423,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"Rufinamide Pspc","code_information":[{"code":"35080299P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":401,"gross_charge":422,"discounted_cash":422,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"Pt Strapping Shoulder Charge","code_information":[{"code":"31029240-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"29240","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":148,"maximum":401,"gross_charge":422,"discounted_cash":422,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"11403 Remove Lesion, Trunk/arm/leg 2.1 To 3.0 Cm Charge","code_information":[{"code":"20011403","type":"CDM"},{"code":"521","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":401,"gross_charge":422,"discounted_cash":422,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":241}]}]},{"description":"Vit D 1, 25 Dihydroxy Pspc","code_information":[{"code":"35082652P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":400,"gross_charge":421,"discounted_cash":421,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"St Evaluate Swallowing Functionchas","code_information":[{"code":"33092610-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92610","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":147,"maximum":400,"gross_charge":421,"discounted_cash":421,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"Trilogy Bone Scr 6.5x30","code_information":[{"code":"1602154","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602154","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":399,"gross_charge":420,"discounted_cash":420,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"20526ther Injection Carp Tunnel -Surg Tech","code_information":[{"code":"12520526","type":"CDM"},{"code":"360","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":398,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Chemo Iv Infus Addl Seq","code_information":[{"code":"14596417","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":398,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Chemotherapy Admin, Subcutaneous Or Im; Non-hormonal Anteri-neoplastic Charge","code_information":[{"code":"14596401","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":398,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Xr Sacrum And Coccyx","code_information":[{"code":"36072220","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":398,"gross_charge":419,"discounted_cash":419,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Heparin Anti-xa Pspc","code_information":[{"code":"35085520P","type":"CDM"},{"code":"301","type":"RC"},{"code":"85520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":396,"gross_charge":417,"discounted_cash":417,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":238}]}]},{"description":"Vascular Endothelial Growth Factor Pspc","code_information":[{"code":"35082397P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":396,"gross_charge":417,"discounted_cash":417,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":238}]}]},{"description":"Ligamax Endo Clip Appl 5m","code_information":[{"code":"1600564","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":396,"gross_charge":417,"discounted_cash":417,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":238}]}]},{"description":"Surgimesh Wn 4x10 Cm","code_information":[{"code":"1602037","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":146,"maximum":395,"gross_charge":416,"discounted_cash":416,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"96369-sc Ther Infusion Up To 1 Hr-tech","code_information":[{"code":"14596369","type":"CDM"},{"code":"260","type":"RC"},{"code":"96369","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":394,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"Xr Femur 2 Views Left","code_information":[{"code":"36073552LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":394,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"Xr Femur 2 Views Right","code_information":[{"code":"36073552RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":394,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"Xr Hip 2-3 Views Lt W/ Pelvis","code_information":[{"code":"36073502LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":394,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"Xr Hip 2-3 Views Rt W/ Pelvis","code_information":[{"code":"36073502RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":394,"gross_charge":415,"discounted_cash":415,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":237}]}]},{"description":"29126- Apply Forearm Splint -Er Tech","code_information":[{"code":"13529126","type":"CDM"},{"code":"450","type":"RC"},{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":392,"gross_charge":413,"discounted_cash":413,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"65205 Foreign Body Removal-eye Techfee","code_information":[{"code":"13565205","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":392,"gross_charge":413,"discounted_cash":413,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"Anoscopy; Diagnostic, With Or Without Collection Of Specimen(s) By Brushing Or Washing (Separate Pro","code_information":[{"code":"20036471","type":"CDM"},{"code":"521","type":"RC"},{"code":"36471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":392,"gross_charge":413,"discounted_cash":413,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":392},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"Iv Push Initial-med Therapy","code_information":[{"code":"14596374","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":391,"gross_charge":412,"discounted_cash":412,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"Insert Temp Catheter Technical Charge","code_information":[{"code":"14551702","type":"CDM"},{"code":"761","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":391,"gross_charge":412,"discounted_cash":412,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"99394 Preventive Medicine 12-17 Years Established","code_information":[{"code":"20099394-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99394","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":144,"maximum":391,"gross_charge":412,"discounted_cash":412,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"11442 Ex Ben Les Face Charge","code_information":[{"code":"20011442","type":"CDM"},{"code":"521","type":"RC"},{"code":"11442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":391,"gross_charge":412,"discounted_cash":412,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":235}]}]},{"description":"Dihydrotesto Pspc","code_information":[{"code":"35080327P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":390,"gross_charge":411,"discounted_cash":411,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Serfas Probe Energy 90-sx 3.5mm","code_information":[{"code":"1601692","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601692","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":390,"gross_charge":411,"discounted_cash":411,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Xr Clavicle Left","code_information":[{"code":"36073000LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":144,"maximum":390,"gross_charge":410,"discounted_cash":410,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Xr Clavicle Right","code_information":[{"code":"36073000RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":144,"maximum":390,"gross_charge":410,"discounted_cash":410,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Speech Sound Prod W/ Language Charge","code_information":[{"code":"CP17640151597080225","type":"CDM"},{"code":"CP17640151597080225","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":390,"gross_charge":410,"discounted_cash":410,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Speech Sound Prod W/ Language Charge","code_information":[{"code":"CP17640151597082510","type":"CDM"},{"code":"CP17640151597082510","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":390,"gross_charge":410,"discounted_cash":410,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":234}]}]},{"description":"Mammography of one breast","code_information":[{"code":"36077065ALT","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"Mammography of one breast","code_information":[{"code":"36077065RTA","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"Mammography of one breast","code_information":[{"code":"36077065LT-LT","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"Mammography of one breast","code_information":[{"code":"36077065RT-RT","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"99382 Preventive Medicine 1-4 Years New -","code_information":[{"code":"20099382-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99382","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"11765-excision Of Nail Fold","code_information":[{"code":"20011765","type":"CDM"},{"code":"521","type":"RC"},{"code":"11765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"Destruction Of Skin Lesions Tech","code_information":[{"code":"20017272","type":"CDM"},{"code":"521","type":"RC"},{"code":"17272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":389,"gross_charge":409,"discounted_cash":409,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"Remove Fb Intranasal Ccc","code_information":[{"code":"20030300","type":"CDM"},{"code":"521","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":388,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"11313 Shave Skin Lesion Single F/e/e/ (Over 2.0 Cm)clinic","code_information":[{"code":"20011313","type":"CDM"},{"code":"521","type":"RC"},{"code":"11313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":388,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":233}]}]},{"description":"59430 Postpartum Care Onlyclinic","code_information":[{"code":"20059430","type":"CDM"},{"code":"521","type":"RC"},{"code":"59430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":387,"gross_charge":407,"discounted_cash":407,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":232}]}]},{"description":"Sirolimus (Rapamune), Bl Pspc","code_information":[{"code":"35080195P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Xr Forearm 2 Views Left","code_information":[{"code":"36073090LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Xr Forearm 2 Views Right","code_information":[{"code":"36073090RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"6.5mm Low Profile Hex Screw","code_information":[{"code":"1602011","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Bone Plug Small","code_information":[{"code":"1601762","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601762","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Distal Cement Spacer Universal","code_information":[{"code":"1601760","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601760","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Percuflex Stent 7frx26cm","code_information":[{"code":"1601480","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601480","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Percuflex Stent 7frx24cm","code_information":[{"code":"1600710","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1600710","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Plug Perfix Xlarge","code_information":[{"code":"1601612","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601612","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Screw Lo-pro,ti","code_information":[{"code":"1602001","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1602001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Screw Locking 02.4mm","code_information":[{"code":"1601876","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601876","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Screw Non- Locking 02.4mm","code_information":[{"code":"1601604","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601604","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Spy Green Agent Surgery Kit","code_information":[{"code":"1602007","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"26750 Treat Finger Fracture Each","code_information":[{"code":"20026750","type":"CDM"},{"code":"521","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142,"maximum":386,"gross_charge":406,"discounted_cash":406,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":231}]}]},{"description":"Culture Typing Pspc","code_information":[{"code":"35087150P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":141,"maximum":384,"gross_charge":404,"discounted_cash":404,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":230}]}]},{"description":"Acp Kit Series 1","code_information":[{"code":"1602010","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":380,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":228}]}]},{"description":"Kit Drill 2.9 Disposable","code_information":[{"code":"1601949","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601949","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":380,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":228}]}]},{"description":"Knot Pusher/suture Cutter","code_information":[{"code":"1601961","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601961","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":380,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":228}]}]},{"description":"31002irrigation Sphenoid Sinus -Sc Tech","code_information":[{"code":"14031002","type":"CDM"},{"code":"761","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":379,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":227}]}]},{"description":"Excision Of Lesion Of Mucosa And Submucosa, Vestibule Of Mouth; With Simple Repair Technical Charge","code_information":[{"code":"14040812","type":"CDM"},{"code":"510","type":"RC"},{"code":"40812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":379,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":227}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"20045380","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":379,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":227}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"14045380","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":379,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":227}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"CP17640152543601632","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":379,"gross_charge":399,"discounted_cash":399,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":227}]}]},{"description":"90750 Shingrix Zoster Vccine (Hzv) Recomb/adjuv [Chas]","code_information":[{"code":"20090750","type":"CDM"},{"code":"521","type":"RC"},{"code":"90750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":376,"gross_charge":396,"discounted_cash":396,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":226}]}]},{"description":"Nt Pro-bnp","code_information":[{"code":"35083880","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":374,"gross_charge":394,"discounted_cash":394,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":225}]}]},{"description":"Plug Perfix Large","code_information":[{"code":"1601611","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601611","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":374,"gross_charge":394,"discounted_cash":394,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":225}]}]},{"description":"Incise Ext Hemorrhoid- Clinic","code_information":[{"code":"20046083","type":"CDM"},{"code":"521","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":374,"gross_charge":394,"discounted_cash":394,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":225}]}]},{"description":"Immune Globulin 10%1 Gm / 10 Ml [Chas]","code_information":[{"code":"CP17640152376499319","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944270002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":137,"maximum":371,"gross_charge":391,"discounted_cash":391,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":223}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Basket Retrieval","code_information":[{"code":"1601635","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601635","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Cannula Tripledam 6mmx7cm","code_information":[{"code":"1601992","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Cannula Tripledam 7x7 Valved","code_information":[{"code":"1601991","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Cutter Linear Proximate 75mm","code_information":[{"code":"1601853","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601853","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Cvc 3-lumen 7fr","code_information":[{"code":"1601958","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Frac Plt Screw Loc.canc. 4.0","code_information":[{"code":"1601925","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601925","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Guide Wire Unthreaded","code_information":[{"code":"1601928","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601928","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":137,"maximum":371,"gross_charge":390,"discounted_cash":390,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Ipe B Cells Total Count, Pspc","code_information":[{"code":"35086355P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":370,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"12013 Rpr Sf Felnlm 2.6-5.0cm Ed Tech","code_information":[{"code":"13512013","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":370,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Xr Elbow 2 Views Left","code_information":[{"code":"36073070LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":136,"maximum":370,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Xr Elbow 2 Views Right","code_information":[{"code":"36073070RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":136,"maximum":370,"gross_charge":389,"discounted_cash":389,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":222}]}]},{"description":"Exc H-f-nk-sp B9+marg 1.1-2","code_information":[{"code":"20011422","type":"CDM"},{"code":"521","type":"RC"},{"code":"11422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":368,"gross_charge":387,"discounted_cash":387,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":221}]}]},{"description":"Catheter Powerpicc 4fr","code_information":[{"code":"1601545","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601545","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":367,"gross_charge":386,"discounted_cash":386,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":220}]}]},{"description":"11422-excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Scalp, N","code_information":[{"code":"20011422-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"11422","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":135,"maximum":367,"gross_charge":386,"discounted_cash":386,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":220}]}]},{"description":"Estrone Pspc","code_information":[{"code":"35082679P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Esoph Ball Dialator 11mm-12mm-13mm","code_information":[{"code":"1601899","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601899","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Esoph Ball Dialator 13.5mm-14.5mm-15.5mm","code_information":[{"code":"1601900","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Esoph Ball Dialator 16mm-17mm-18mm","code_information":[{"code":"1601901","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601901","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Esoph Ball Dialator 6mm-7mm-8mm","code_information":[{"code":"1601897","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601897","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Esoph Ball Dialator 8.5mm-9.5mm-10mm","code_information":[{"code":"1601898","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601898","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"99393 Preventive Medicine 5-11 Years Established","code_information":[{"code":"20099393-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99393","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"17262 Destruction Of Skin Lesions-clinic","code_information":[{"code":"20017262","type":"CDM"},{"code":"521","type":"RC"},{"code":"17262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":366,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Ot Eval","code_information":[{"code":"CP17640151596305637","type":"CDM"},{"code":"CP17640151596305637","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":365,"gross_charge":384,"discounted_cash":384,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":219}]}]},{"description":"Chronic Urticaria Index, Fcer Ige Receptor Ab Pspc","code_information":[{"code":"35086352P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Gi Pathogen Panel Rps Pspc","code_information":[{"code":"35087507RPS","type":"CDM"},{"code":"306","type":"RC"},{"code":"87507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Respiratory Pathogen Panel (Rps) Pspc","code_information":[{"code":"3500099UP","type":"CDM"},{"code":"302","type":"RC"},{"code":"0099U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Respiratory Pathogen Panel Pspc","code_information":[{"code":"350009U","type":"CDM"},{"code":"302","type":"RC"},{"code":"0099U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"K-wire","code_information":[{"code":"1601594","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601594","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Nsg Facility Care Init 45 Min","code_information":[{"code":"20099306-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99306","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":134,"maximum":364,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Annual Wellness Visit, Initial (Awv)","code_information":[{"code":"200G0438-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0438","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":134,"maximum":363,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Annual Wellness Visit, Subsequent (Awv)","code_information":[{"code":"200G0439-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0439","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":134,"maximum":363,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":218}]}]},{"description":"Hydroxychloroquine, (Nms Via Rps) Pspc","code_information":[{"code":"35080375P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":362,"gross_charge":381,"discounted_cash":381,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Xr Hip 1 View Lt W/ Pelvis","code_information":[{"code":"36073501LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":362,"gross_charge":381,"discounted_cash":381,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Xr Hip 1 View Rt W/ Pelvis","code_information":[{"code":"36073501RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":362,"gross_charge":381,"discounted_cash":381,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"20099204","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":362,"gross_charge":381,"discounted_cash":381,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"11421 Remove Lesion, Scalp/neck/hand/foot .6 To 1.0 Cm Charge","code_information":[{"code":"20011421","type":"CDM"},{"code":"521","type":"RC"},{"code":"11421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":362,"gross_charge":381,"discounted_cash":381,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Knot Pusher/suture Cutter & Slotted  Can Set","code_information":[{"code":"1601719","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601719","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":361,"gross_charge":380,"discounted_cash":380,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Plug Perfix Medium","code_information":[{"code":"1601610","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601610","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":361,"gross_charge":380,"discounted_cash":380,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Plug Perfix Small","code_information":[{"code":"1601609","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601609","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":361,"gross_charge":380,"discounted_cash":380,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":217}]}]},{"description":"Chemo Iv Push Addl Drug","code_information":[{"code":"14596411","type":"CDM"},{"code":"331","type":"RC"},{"code":"96411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":360,"gross_charge":379,"discounted_cash":379,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":216}]}]},{"description":"Needle Scorpion Surefire","code_information":[{"code":"1601951","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":360,"gross_charge":379,"discounted_cash":379,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":216}]}]},{"description":"Orthopedics Custom","code_information":[{"code":"1601582","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601582","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":360,"gross_charge":379,"discounted_cash":379,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":216}]}]},{"description":"Suturelasso Sd, Crescent","code_information":[{"code":"1601950","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601950","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":360,"gross_charge":379,"discounted_cash":379,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":216}]}]},{"description":"Cv Electrocardiogram (Ekg)","code_information":[{"code":"36093005","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":359,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":215}]}]},{"description":"Disp Kit, Trans-tib Acl W/o Sawbld","code_information":[{"code":"1601955","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":359,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":215}]}]},{"description":"Drill Bit/qc","code_information":[{"code":"1601687","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601687","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":359,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":215}]}]},{"description":"Instrument Kit For Small Joint Suturetak Disposable","code_information":[{"code":"1601976","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601976","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":359,"gross_charge":378,"discounted_cash":378,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":215}]}]},{"description":"Nhdc Mgmt > 30 Min","code_information":[{"code":"20099316-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99316","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":132,"maximum":358,"gross_charge":377,"discounted_cash":377,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":215}]}]},{"description":"X-ray Exam Chest 1 View","code_information":[{"code":"36071045","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Xr Sternum Minimum 2 Views","code_information":[{"code":"36071120","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Xr Wrist Complete Left","code_information":[{"code":"36073110LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Xr Wrist Complete Right","code_information":[{"code":"36073110RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Cricothyrotomy Kit","code_information":[{"code":"1601758","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601758","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Percuflex Stent 7frx22cm","code_information":[{"code":"1601326","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601326","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"90716 Varivaxvaricella Virus Vacc [Chas]","code_information":[{"code":"20090716","type":"CDM"},{"code":"521","type":"RC"},{"code":"90716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":357,"gross_charge":376,"discounted_cash":376,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Xr Spine Entire 1 View","code_information":[{"code":"36072081","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":356,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"Cement Mixing Pressurizer","code_information":[{"code":"1602130","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602130","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":356,"gross_charge":375,"discounted_cash":375,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":214}]}]},{"description":"16020 Dress/debride P-thick Burned Tech","code_information":[{"code":"12516020","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":354,"gross_charge":373,"discounted_cash":373,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":213}]}]},{"description":"Alteplase 2 Mg Vial[chas]","code_information":[{"code":"CP17640152376444577","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":130,"maximum":353,"gross_charge":372,"discounted_cash":372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Serfas Probe Contour 3.5mm","code_information":[{"code":"1601685","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601685","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":353,"gross_charge":372,"discounted_cash":372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Serfas Probe Hook 3.5mm","code_information":[{"code":"1601706","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601706","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":353,"gross_charge":372,"discounted_cash":372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Tray Powerpicc 5fr Dl","code_information":[{"code":"1601939","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601939","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":353,"gross_charge":372,"discounted_cash":372,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"29105 Application Long Arm Splint Shoulder Hand Techfee","code_information":[{"code":"13529105","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":352,"gross_charge":371,"discounted_cash":371,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"43752 Nasal/orogastric W/tupe Plmt- Ed Tech","code_information":[{"code":"12543752","type":"CDM"},{"code":"450","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":352,"gross_charge":371,"discounted_cash":371,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Initial Preventive Exam","code_information":[{"code":"200G0402-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0402","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":130,"maximum":352,"gross_charge":370,"discounted_cash":370,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"14099205","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":351,"gross_charge":369,"discounted_cash":369,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":210}]}]},{"description":"11441 Ex Ben Les Face Ear Lips","code_information":[{"code":"20011441","type":"CDM"},{"code":"521","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":351,"gross_charge":369,"discounted_cash":369,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":210}]}]},{"description":"Hp Mthfr Pspc","code_information":[{"code":"35081291HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"81291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Xr Calcaneous Min 2 Views Left","code_information":[{"code":"36073650LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Xr Calcaneous Min 2 Views Right","code_information":[{"code":"36073650RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"20045378","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"14045378","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"CP17640152543596406","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":349,"gross_charge":367,"discounted_cash":367,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Cystatin C Pspc","code_information":[{"code":"35082610P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":348,"gross_charge":366,"discounted_cash":366,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"10120 Incision & Removal Of Foreign Body, Subcutaneous Tissues; Simple Charge","code_information":[{"code":"20010120","type":"CDM"},{"code":"521","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":348,"gross_charge":366,"discounted_cash":366,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Excision, Benign Lesion Including Margins, Trunk, Arms Or Legs; 1.1 To 2.0 Cm Technical Charge","code_information":[{"code":"20011402","type":"CDM"},{"code":"521","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":348,"gross_charge":366,"discounted_cash":366,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":209}]}]},{"description":"Cd57 Panel Pspc","code_information":[{"code":"35086356P","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":347,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":208}]}]},{"description":"Loading Unit Multi 4.8mm","code_information":[{"code":"1600573","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":347,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":208}]}]},{"description":"Nitinol Wires Versitomic Rr","code_information":[{"code":"1602054","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":347,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":208}]}]},{"description":"42809-remove Pharynx Foreign Body","code_information":[{"code":"13542809","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Hiv Rna Viral Load, Us Pspc","code_information":[{"code":"35087536P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Pyruvate Kinase (Rps) Pspc","code_information":[{"code":"35084220PYR","type":"CDM"},{"code":"301","type":"RC"},{"code":"84220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"97605 Wound Vac Neg <=50 Cm Charge","code_information":[{"code":"14597605","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Wound(s) Care Non-selective","code_information":[{"code":"14597602","type":"CDM"},{"code":"760","type":"RC"},{"code":"97602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Wound Care First 20 Sqcm","code_information":[{"code":"31097597","type":"CDM"},{"code":"421","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":346,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Plate Self-comp, Sm","code_information":[{"code":"1601766","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601766","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":345,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"51705 Change Of Cystostomy Tube; Simple","code_information":[{"code":"20051705","type":"CDM"},{"code":"521","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":345,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"Nipple Exploration.excision","code_information":[{"code":"20010140","type":"CDM"},{"code":"521","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127,"maximum":345,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":207}]}]},{"description":"31500insert Emergency Airwaytech","code_information":[{"code":"10531500","type":"CDM"},{"code":"110","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":342,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":205}]}]},{"description":"Mesh Proloop Small","code_information":[{"code":"1600610","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1600610","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":342,"gross_charge":360,"discounted_cash":360,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":205}]}]},{"description":"Meningococcal Polysaccharide Vaccine (Any Group(s)), For Subcutaneous Use Charge","code_information":[{"code":"20090733","type":"CDM"},{"code":"521","type":"RC"},{"code":"90733","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":341,"gross_charge":359,"discounted_cash":359,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":205}]}]},{"description":"15275-skin Sub Graft Face/hk/hf/g-sc Tech","code_information":[{"code":"14015275","type":"CDM"},{"code":"510","type":"RC"},{"code":"15275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":340,"gross_charge":358,"discounted_cash":358,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":204}]}]},{"description":"99392 Preventive Medicine 1-4 Years Established","code_information":[{"code":"20099392-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99392","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":125,"maximum":340,"gross_charge":358,"discounted_cash":358,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":204}]}]},{"description":"12004- Rpr S/n/a/as/gen/trk 7.16-12.5cm-ed Tech","code_information":[{"code":"13512004","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"12011 Rpr/f/e/e/n/l/m 2.5cm/< Ed Tech","code_information":[{"code":"13512011","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"Acylcarnitine Quant Prof Pspc","code_information":[{"code":"35082017P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"26725-treat Finger Fracture Each-sc Tech","code_information":[{"code":"14026725","type":"CDM"},{"code":"510","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"Ball Tip Electrode 5fr 65cm","code_information":[{"code":"1601824","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601824","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"Bugbec Elect 5fr 65cm","code_information":[{"code":"1600121","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"99381 Preventive Medicine < 1 Year New","code_information":[{"code":"20099381-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99381","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"12015 Simple Repair 7.6-12.5 Cm Face Clinic Charge","code_information":[{"code":"20012015","type":"CDM"},{"code":"521","type":"RC"},{"code":"12015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"Topotecan 1 Mg/ml4 Ml Sdv [Chs]","code_information":[{"code":"CP17640152376551931","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703471401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":125,"maximum":339,"gross_charge":357,"discounted_cash":357,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ez-io 45mm Intraoss Ndle","code_information":[{"code":"1601565","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601565","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":338,"gross_charge":356,"discounted_cash":356,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"Ez-io Ad Intraosseous Nee","code_information":[{"code":"1600397","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600397","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":338,"gross_charge":356,"discounted_cash":356,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":203}]}]},{"description":"92587 Otoacoustic Emissions Charge","code_information":[{"code":"11592587","type":"CDM"},{"code":"471","type":"RC"},{"code":"92587","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":337,"gross_charge":355,"discounted_cash":355,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":202}]}]},{"description":"Metanephrines, Fractioned Ur Pspc","code_information":[{"code":"35083835P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":336,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":202}]}]},{"description":"94010 Spirometry Charge","code_information":[{"code":"30094010","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":336,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":202}]}]},{"description":"Subsequent Eval Mgmnt Of Pt An Annual Nsg Facility Assessment. Physician Spends 25 Minutes","code_information":[{"code":"20099309-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99309","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":124,"maximum":336,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":202}]}]},{"description":"Tryptase Pspc","code_information":[{"code":"35083520TP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":334,"gross_charge":352,"discounted_cash":352,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"65205 Rmvl Fb Ext Eye Conj Suped Tech","code_information":[{"code":"12565205","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":334,"gross_charge":352,"discounted_cash":352,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Shave Skin Lesion F/e/e/n/l 1.1 To 2.0 Cmclinic","code_information":[{"code":"20011312","type":"CDM"},{"code":"521","type":"RC"},{"code":"11312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":334,"gross_charge":352,"discounted_cash":352,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201}]}]},{"description":"Smpl Repair Of Sprfcl Wounds Of Scalp, Neck, Axillae, Ext Genitalia, Trunk, Extrem 2.6-7.5 Cm  Techn","code_information":[{"code":"13512002","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":333,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Etoposide 20 Mg/ml50 Ml Sol [Chas]","code_information":[{"code":"CP17640152376478606","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729011411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":123,"maximum":333,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Gemcitabine 38 Mg/ml2 Gm/52.6ml Sdpf [Chas]","code_information":[{"code":"CP17640152376488942","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":123,"maximum":333,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200}]}],"drug_information":{"unit":38,"type":"ME"}},{"description":"Shave (Epi)dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 2.0+ Cm Charge","code_information":[{"code":"20011308","type":"CDM"},{"code":"521","type":"RC"},{"code":"11308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":333,"gross_charge":350,"discounted_cash":350,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":199}]}]},{"description":"30905-control Of Nosebleed","code_information":[{"code":"13530905","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":332,"gross_charge":349,"discounted_cash":349,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":199}]}]},{"description":"Xr Toes Left","code_information":[{"code":"36073660LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":122,"maximum":331,"gross_charge":348,"discounted_cash":348,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Xr Toes Right","code_information":[{"code":"36073660RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":122,"maximum":331,"gross_charge":348,"discounted_cash":348,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Blood Gas Venous","code_information":[{"code":"35082803V","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Histoplasma Ag, Pspc","code_information":[{"code":"35087385P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Ph Arterial","code_information":[{"code":"35082803","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"29580 Strapping Unna Booted Tech","code_information":[{"code":"12529580","type":"CDM"},{"code":"450","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Us Echo Doppler Limited","code_information":[{"code":"38093321","type":"CDM"},{"code":"483","type":"RC"},{"code":"93321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Zoster (Shingles) Vaccine, Live, Subcutaneous Injection Poc","code_information":[{"code":"20090736","type":"CDM"},{"code":"521","type":"RC"},{"code":"90736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"11982 Removal, Non-biodegradable Drug Delivery Implant","code_information":[{"code":"20011982","type":"CDM"},{"code":"521","type":"RC"},{"code":"11982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":330,"gross_charge":347,"discounted_cash":347,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":198}]}]},{"description":"Hsv 1 & 2 Dna, Qual Pspc","code_information":[{"code":"35087798P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":329,"gross_charge":346,"discounted_cash":346,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":197}]}]},{"description":"Hepatitis C Virus Rna Detect/qnt (Rps) Pspc","code_information":[{"code":"35087522P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":329,"gross_charge":346,"discounted_cash":346,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":197}]}]},{"description":"93798 Cardiac Rehab Phase Ii-kx Charge","code_information":[{"code":"34093798-KX","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT","modifier":"KX"}],"standard_charges":[{"setting":"outpatient","modifier_code":["KX"],"minimum":121,"maximum":328,"gross_charge":345,"discounted_cash":345,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":197}]}]},{"description":"Cardiac Rehab Phase Ii W/ Cont Ecg Monitoring","code_information":[{"code":"34093798","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":328,"gross_charge":345,"discounted_cash":345,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":197}]}]},{"description":"Shave Skin Lesion > 2.0 Cmclinic","code_information":[{"code":"20011303","type":"CDM"},{"code":"521","type":"RC"},{"code":"11303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":326,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":196}]}]},{"description":"Homocysteine. Ser Pspc","code_information":[{"code":"35083090P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":325,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":195}]}]},{"description":"11730 Avulsion Of Nail Plate, Partial Or Complete, Simple; Single Charge","code_information":[{"code":"20011730","type":"CDM"},{"code":"521","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":325,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":195}]}]},{"description":"Aldosterone/renin Activity Ratio","code_information":[{"code":"35082088P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":324,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":194}]}]},{"description":"Insulin Abs Pspc","code_information":[{"code":"35086337P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":324,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":194}]}]},{"description":"Porpho, Rndm Ur Pspc","code_information":[{"code":"35084120P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":324,"gross_charge":341,"discounted_cash":341,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":194}]}]},{"description":"Pt Select Debrid Wo Anes Assistant Units","code_information":[{"code":"31097597-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":119,"maximum":323,"gross_charge":340,"discounted_cash":340,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":194}]}]},{"description":"Obstetric blood test panel","code_information":[{"code":"35080055P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":322,"gross_charge":339,"discounted_cash":339,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"11981 Insertion Drug Delivery Implantcontracept Syst","code_information":[{"code":"20011981","type":"CDM"},{"code":"521","type":"RC"},{"code":"11981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":322,"gross_charge":339,"discounted_cash":339,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Methylnaltrexone 12 Mg/0.6 Ml [Chas]","code_information":[{"code":"CP17640152376516408","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":119,"maximum":322,"gross_charge":339,"discounted_cash":339,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Massage Charge Units","code_information":[{"code":"32097124-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Neuromuscular Reeducation Charges","code_information":[{"code":"32097112-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Xr Wrist 2 Views Left","code_information":[{"code":"36073100LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Xr Wrist 2 Views Right","code_information":[{"code":"36073100RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"St Dysphagia Therapychas","code_information":[{"code":"33092526-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Absorbable Hmostatic Particles 1 G  (Arista Ah)","code_information":[{"code":"1601981","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601981","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":321,"gross_charge":338,"discounted_cash":338,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":193}]}]},{"description":"Remove Malig Lesion W/margins, Trunk, Arms, Or Legs; Diam 2.1 To 3.0 Cm Charge","code_information":[{"code":"14011603","type":"CDM"},{"code":"510","type":"RC"},{"code":"11603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":319,"gross_charge":336,"discounted_cash":336,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":192}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"14029826","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":319,"gross_charge":336,"discounted_cash":336,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":192}]}]},{"description":"99350-level 4 Home Visit","code_information":[{"code":"20099350","type":"CDM"},{"code":"521","type":"RC"},{"code":"99350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":319,"gross_charge":336,"discounted_cash":336,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":192}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"CP17640152543590556","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":319,"gross_charge":336,"discounted_cash":336,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":192}]}]},{"description":"80230 Infliximab Activity Pspc","code_information":[{"code":"35080230P","type":"CDM"},{"code":"302","type":"RC"},{"code":"80230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":317,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":190}]}]},{"description":"Xr Femur 1 View Left","code_information":[{"code":"36073551","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":317,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":190}]}]},{"description":"Colposcopy Of The Cervix W/biopsy And Endocervical Curettage Technical Charge","code_information":[{"code":"20057454","type":"CDM"},{"code":"521","type":"RC"},{"code":"57454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":317,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":190}]}]},{"description":"11302-shave Skin Lesion 1.1-2.0 Cm","code_information":[{"code":"14011302","type":"CDM"},{"code":"510","type":"RC"},{"code":"11302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":316,"gross_charge":333,"discounted_cash":333,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":190}]}]},{"description":"St Eval Speech Soundchas","code_information":[{"code":"33092522-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92522","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":116,"maximum":315,"gross_charge":332,"discounted_cash":332,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":189}]}]},{"description":"Playmaker Brace Lg","code_information":[{"code":"1600729","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600729","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":116,"maximum":315,"gross_charge":332,"discounted_cash":332,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":189}]}]},{"description":"11106 Incisional Bx Of Skin (Eg, Wedge)-clinic","code_information":[{"code":"20011106","type":"CDM"},{"code":"521","type":"RC"},{"code":"11106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116,"maximum":314,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":189}]}]},{"description":"12014-repair F/e/e/n/l/m 5.1-7.5 Cm-er Tech","code_information":[{"code":"13512014","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":314,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":188}]}]},{"description":"Xr Finger Left","code_information":[{"code":"36073140LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":115,"maximum":314,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":188}]}]},{"description":"Xr Finger Right","code_information":[{"code":"36073140RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":115,"maximum":314,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":188}]}]},{"description":"12020 Closure Of Split Wound Sc Tech","code_information":[{"code":"14012020","type":"CDM"},{"code":"510","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":314,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":188}]}]},{"description":"11307 Shave Skin Lesion 1.1-2.0cmclinic","code_information":[{"code":"20011307","type":"CDM"},{"code":"521","type":"RC"},{"code":"11307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":314,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":188}]}]},{"description":"Acth, Plasma Pspc","code_information":[{"code":"35082024P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"Xr Ankle 2 Views Left","code_information":[{"code":"36073600LT-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"Xr Ankle 2 Views Right","code_information":[{"code":"36073600RT-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"99214 Office/op Established  Visit Level 4","code_information":[{"code":"20099214-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"99214","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"90678 Rsv Vaccine- Abrysvo [Chas]","code_information":[{"code":"20090678","type":"CDM"},{"code":"521","type":"RC"},{"code":"90678","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"11401 Remove Lesion, Trunk/arm/leg .6 To 1.0 Cm Charge","code_information":[{"code":"20011401","type":"CDM"},{"code":"521","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}]},{"description":"Palonosetron 0.25 Mg/5 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376532463","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":115,"maximum":312,"gross_charge":328,"discounted_cash":328,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":187}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Paraneoplastic Auto Ab, Ria Quant Pspc","code_information":[{"code":"35083519P2","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":311,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":186}]}]},{"description":"Speech Fluency Evalspeech Fluency Eval Charge","code_information":[{"code":"33092521-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92521","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":114,"maximum":311,"gross_charge":327,"discounted_cash":327,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":186}]}]},{"description":"C Telopeptide, Ser Pspc","code_information":[{"code":"35082523P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":309,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"69210 Remove Impacted Ear Wax Unied Tech","code_information":[{"code":"12569210","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":309,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"20099203","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":309,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"58301 Iud, Remove Charge","code_information":[{"code":"20058301","type":"CDM"},{"code":"521","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":309,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"69200 Clear Outer Canal Chargeed Tech","code_information":[{"code":"13569200","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":308,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"Troponin I","code_information":[{"code":"35084484","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":308,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"Xr Sinuses Paranasal < 3 Views","code_information":[{"code":"36070210","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":308,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"28490 Closed Trt Of Fracture Great Toe/phalanx Or Phalanges W/o Manipulation-clinic","code_information":[{"code":"20028490","type":"CDM"},{"code":"521","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":308,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":185}]}]},{"description":"Cmv Igm Abs, Qt Pspc","code_information":[{"code":"35086645P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":307,"gross_charge":323,"discounted_cash":323,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":184}]}]},{"description":"Surgi-cel","code_information":[{"code":"1600920","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":306,"gross_charge":322,"discounted_cash":322,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":184}]}]},{"description":"29130 Apply Finger Splint; Static- Ed Tech","code_information":[{"code":"13529130","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Lyme , Serum Wb Pspc","code_information":[{"code":"35086617P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Tick Id W/reflex To Borrelia Sp Pcr Pspc","code_information":[{"code":"35087168P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Vit B1, Whole Blood Pspc","code_information":[{"code":"35084425P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Labor Chg Per Hr Charge","code_information":[{"code":"120001","type":"CDM"},{"code":"720","type":"RC"},{"code":"CP120001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"28490 Fracture Toe Clinic Charge","code_information":[{"code":"14028490","type":"CDM"},{"code":"510","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Electrode Fulgurating 2fr 115cm","code_information":[{"code":"1601584","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601584","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"Inlet Closure Kit Sterile","code_information":[{"code":"1600504","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":305,"gross_charge":321,"discounted_cash":321,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":183}]}]},{"description":"90734 Menveo -Meningococcal Conj-serogroup A/c/y/w13 [Chas]","code_information":[{"code":"20090734-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90734","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":112,"maximum":304,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":182}]}]},{"description":"Benzathine Penicillin-procaine Penicillin","code_information":[{"code":"200J0558","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":304,"gross_charge":320,"discounted_cash":320,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":182}]}]},{"description":"Flow Cyto, Csm Leukaym Pspc","code_information":[{"code":"35088184P","type":"CDM"},{"code":"300","type":"RC"},{"code":"88184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":303,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":182}]}]},{"description":"Hgb Electro Prof Pspc","code_information":[{"code":"35082664P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":303,"gross_charge":319,"discounted_cash":319,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":182}]}]},{"description":"11440 Remove Lesion, Face/lid/ear/nose/lip <.5 Cm Charge","code_information":[{"code":"14011440","type":"CDM"},{"code":"360","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":302,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"11730- Removal Of Nail Plate -Tech","code_information":[{"code":"10511730","type":"CDM"},{"code":"761","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":302,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"Mesh Flat Sheet 3 X 6","code_information":[{"code":"1601769","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601769","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":302,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"Tray Power Picc 4fr","code_information":[{"code":"1601738","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601738","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":302,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"Trocar Endpth Xcel 12mm 150ml","code_information":[{"code":"1601755","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601755","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":302,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"30901 Control Nose Bleed Ed Charge","code_information":[{"code":"13530901","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":301,"gross_charge":317,"discounted_cash":317,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"Blood Culture","code_information":[{"code":"35087040","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":301,"gross_charge":317,"discounted_cash":317,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"11311 Shave (Epi)dermal Lesion, Single, Face/ears/eye/nose/lips/muc Memb; Diam 0.6 To 1.0 Cm Charge","code_information":[{"code":"20011311","type":"CDM"},{"code":"521","type":"RC"},{"code":"11311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":301,"gross_charge":317,"discounted_cash":317,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"11976 Removal, Implantable Contraceptive Capsules Charge","code_information":[{"code":"20011976","type":"CDM"},{"code":"521","type":"RC"},{"code":"11976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":301,"gross_charge":317,"discounted_cash":317,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":181}]}]},{"description":"Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Im Use Poc","code_information":[{"code":"20090734","type":"CDM"},{"code":"521","type":"RC"},{"code":"90734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":299,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":180}]}]},{"description":"Crossmatch Ahg Interp","code_information":[{"code":"35086922","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":298,"gross_charge":314,"discounted_cash":314,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":179}]}]},{"description":"Bd Dexa Appendicular","code_information":[{"code":"36077081","type":"CDM"},{"code":"320","type":"RC"},{"code":"77081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":298,"gross_charge":314,"discounted_cash":314,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":179}]}]},{"description":"J0561 Penicillin G Benz 600,000un100,000un [Chas]","code_information":[{"code":"200J0561","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":298,"gross_charge":314,"discounted_cash":314,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":179}]}]},{"description":"Trocar Endpth Excel 11mm","code_information":[{"code":"1601169","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601169","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":297,"gross_charge":313,"discounted_cash":313,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":178}]}]},{"description":"Factor Viii Activity (Rps) Pspc","code_information":[{"code":"35085240P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":296,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":178}]}]},{"description":"94761 Oximetry Multiple Charge","code_information":[{"code":"30094761","type":"CDM"},{"code":"460","type":"RC"},{"code":"94761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":296,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":178}]}]},{"description":"Ez-io Ped Intraosseons Ne","code_information":[{"code":"1600398","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600398","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":296,"gross_charge":312,"discounted_cash":312,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":178}]}]},{"description":"11302 Shave Skin Lesion, Trunk, Arms Or Legs (1.1 To 2.0cm)clinic","code_information":[{"code":"20011302","type":"CDM"},{"code":"521","type":"RC"},{"code":"11302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":295,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":177}]}]},{"description":"Destruction  Malignant Lesion  Face  Ears  Eyelids  Nose  Lips  Mucous Membrane  0.5 Cm Or Less","code_information":[{"code":"20017280","type":"CDM"},{"code":"521","type":"RC"},{"code":"17280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":295,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":177}]}]},{"description":"Pregnenolone Pspc","code_information":[{"code":"35084140P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":294,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":176}]}]},{"description":"Unmc Consult, Pspc","code_information":[{"code":"35088321UNMC","type":"CDM"},{"code":"300","type":"RC"},{"code":"88321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":294,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":176}]}]},{"description":"99391 Preventive Medicine < 1 Year Established","code_information":[{"code":"20099391-EP","type":"CDM"},{"code":"521","type":"RC"},{"code":"99391","type":"CPT","modifier":"EP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["EP"],"minimum":108,"maximum":294,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":176}]}]},{"description":"T-plate 3.5mm","code_information":[{"code":"1601886","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601886","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":293,"gross_charge":308,"discounted_cash":308,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":176}]}]},{"description":"Crossmatch, Agt Phase, Arc","code_information":[{"code":"35086922ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":292,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":175}]}]},{"description":"Respite Care-hospice Charge","code_information":[{"code":"105402","type":"CDM"},{"code":"655","type":"RC"},{"code":"CP105402","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":292,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":175}]}]},{"description":"Knee Brace Extender Plus","code_information":[{"code":"1601505","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601505","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":292,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":175}]}]},{"description":"Ms Panel Pspc","code_information":[{"code":"35083916P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":291,"gross_charge":306,"discounted_cash":306,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":174}]}]},{"description":"Respiratory Inf Agent, Na Amp Pspc","code_information":[{"code":"35087486P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":290,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":174}]}]},{"description":"Respiratory Inf Agent, Na Pspc","code_information":[{"code":"35087581P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":290,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":174}]}]},{"description":"Ex Ben Les Trnk Arm Leg","code_information":[{"code":"14011403","type":"CDM"},{"code":"510","type":"RC"},{"code":"11403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":290,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":174}]}]},{"description":"Sugammadex 100 Mg/ml2 Ml [Chas]","code_information":[{"code":"CP17640152376550535","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":290,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":174}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Uds 8","code_information":[{"code":"35080306","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":289,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Esoph Ball Dialator 20mm","code_information":[{"code":"1601501","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601501","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":289,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Esoph Ball Dilator 12mm","code_information":[{"code":"1601502","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601502","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":289,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Playmaker Brace Med","code_information":[{"code":"1600730","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600730","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":289,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Playmaker, Pop Brace Sm","code_information":[{"code":"1601524","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":289,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Infectious Agent Ag","code_information":[{"code":"35087449C","type":"CDM"},{"code":"302","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Infectious Agent Ag Pspc","code_information":[{"code":"35087449","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"U Catecholamine Add On Charge","code_information":[{"code":"35082384P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Hypercoagulable Panel Pspc","code_information":[{"code":"35081240HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Removal Of Implant, Superficial","code_information":[{"code":"14020670","type":"CDM"},{"code":"510","type":"RC"},{"code":"20670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Playmaker, Pop Brace Xxl","code_information":[{"code":"1601544","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601544","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Prontosan Irrigation Solution 350ml","code_information":[{"code":"1601967","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601967","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Reload For Flex 45mm Stapler White","code_information":[{"code":"1601827","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Screw Acl Interference (Uniersal Wedge)","code_information":[{"code":"1601841","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Stapler Proximate Rl Linear","code_information":[{"code":"1601856","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601856","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"17111 Destruct Lesion 15 Or Moreclinic","code_information":[{"code":"20017111","type":"CDM"},{"code":"521","type":"RC"},{"code":"17111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":288,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":173}]}]},{"description":"Pth, Intact Pspc","code_information":[{"code":"35083970P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":287,"gross_charge":302,"discounted_cash":302,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":172}]}]},{"description":"Ot Strapping, Hand, Finger Units","code_information":[{"code":"32029280-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"29280","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":106,"maximum":287,"gross_charge":302,"discounted_cash":302,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":172}]}]},{"description":"Change Of Cystostomy Tube; Simple.","code_information":[{"code":"10551705","type":"CDM"},{"code":"761","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":286,"gross_charge":301,"discounted_cash":301,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":172}]}]},{"description":"28272-release Of Toe Joint Each-sc Tech","code_information":[{"code":"14028272","type":"CDM"},{"code":"510","type":"RC"},{"code":"28272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":285,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":171}]}]},{"description":"Needle Rp360 Flexible","code_information":[{"code":"1601772","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601772","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":285,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":171}]}]},{"description":"Suction Probe 90-s Cruise 4.0mmx135mm","code_information":[{"code":"1601822","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601822","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":285,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":171}]}]},{"description":"Nhdc Mgmt < 30 Min","code_information":[{"code":"20099315-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99315","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":105,"maximum":285,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":171}]}]},{"description":"Ex Ben Les Fce/er/ns/lip","code_information":[{"code":"20011440","type":"CDM"},{"code":"521","type":"RC"},{"code":"11440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":285,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":171}]}]},{"description":"11400 Remove Lesion, Trunk/arm/leg <.5 Cm Charge","code_information":[{"code":"20011400","type":"CDM"},{"code":"521","type":"RC"},{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":284,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}]},{"description":"30901 Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/or Packing) Any Method Charge","code_information":[{"code":"20030901","type":"CDM"},{"code":"521","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":284,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}]},{"description":"Shaving Of Lesion Scalp, Neck, Hands, Ft, Genitalia; 0.6 To 1.0 Cm Technical Charge","code_information":[{"code":"20011306","type":"CDM"},{"code":"521","type":"RC"},{"code":"11306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":284,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}]},{"description":"Carboplatin Inj 10mg/ml60 Ml  Mdpf [Chas]","code_information":[{"code":"CP17640152376455062","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703423901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":104,"maximum":283,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxygen Therapy Per Day","code_information":[{"code":"1600684","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1600684","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":283,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}]},{"description":"90697 Vaxelis [Chas]","code_information":[{"code":"20090697","type":"CDM"},{"code":"521","type":"RC"},{"code":"90697","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":283,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":170}]}]},{"description":"41110-excision Of Tongue Lesion-sc Tech","code_information":[{"code":"14041110","type":"CDM"},{"code":"510","type":"RC"},{"code":"41110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":282,"gross_charge":297,"discounted_cash":297,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":169}]}]},{"description":"Excision Of Lesion, Face, Ears, Eyelids, Nose, Lip114412","code_information":[{"code":"14011441","type":"CDM"},{"code":"510","type":"RC"},{"code":"11441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":282,"gross_charge":297,"discounted_cash":297,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":169}]}]},{"description":"Roller Ball Electrode","code_information":[{"code":"1600772","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600772","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":281,"gross_charge":296,"discounted_cash":296,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":169}]}]},{"description":"12014 Rpr F/e/e/n/l/m 5.1-7.5 Cm","code_information":[{"code":"20012014","type":"CDM"},{"code":"521","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":281,"gross_charge":296,"discounted_cash":296,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":169}]}]},{"description":"99305 Initial Nursing Facility Care (History, Exam, And Mdm. Typically 35 Min)","code_information":[{"code":"20099305-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99305","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":103,"maximum":280,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"91322 Spikevax (Covid-19) Vaccine Charge [Chas]","code_information":[{"code":"20091322","type":"CDM"},{"code":"521","type":"RC"},{"code":"91322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":280,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"11420 Remove Lesion, Scalp/neck/hand/foot <0.5 Cm Charge","code_information":[{"code":"20011420","type":"CDM"},{"code":"521","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":280,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"Hsv Iso Culture Pspc","code_information":[{"code":"35087252P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":279,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"Protein C, Total Antigen (Rps) Pspc","code_information":[{"code":"35085302P","type":"CDM"},{"code":"302","type":"RC"},{"code":"85302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":279,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"Surg Recovery Phase I Charge","code_information":[{"code":"125008","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP125008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":279,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":168}]}]},{"description":"3.2mmx30mm Rnglc+acet Drill Bit","code_information":[{"code":"1602151","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602151","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":278,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":167}]}]},{"description":"32555aspirate Pleura W/ Imaging -Tech","code_information":[{"code":"10532555","type":"CDM"},{"code":"110","type":"RC"},{"code":"32555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":277,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Bcr/abl Mjr Bp, Qual (Rps) Pspc","code_information":[{"code":"35081206MP","type":"CDM"},{"code":"301","type":"RC"},{"code":"81206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Bcr/abl Mnr Bp, Qual (Rps) Pspc","code_information":[{"code":"35081207MP","type":"CDM"},{"code":"301","type":"RC"},{"code":"81207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Thallium, Whole Blood, Pspc","code_information":[{"code":"35083018P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Cement Mixing Bowl & Cartridge","code_information":[{"code":"1601664","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601664","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Ball Dialator 15mm X 8cm","code_information":[{"code":"1600065","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Brace Elbow T-scope Reg L","code_information":[{"code":"1601520","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Brace Elbw T-scope Long L","code_information":[{"code":"1601518","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601518","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Brace Elbw T-scope Long R","code_information":[{"code":"1601523","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Brace Elbw T-scope Reg R","code_information":[{"code":"1601519","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601519","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Catheter Per-q-cath 3fr","code_information":[{"code":"1601585","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601585","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Catheter Ultrathane Mac-loc Locking Loop","code_information":[{"code":"1601778","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601778","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Cholangiogram Cath 5mm32","code_information":[{"code":"1600223","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600223","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Endopath Disp Clip 10mm/l","code_information":[{"code":"1600368","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600368","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Esoph Ball Dialator 18mm","code_information":[{"code":"1601490","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601490","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Gastrostomy Low-profile Tube 24fr","code_information":[{"code":"1601885","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601885","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Stryker Mixevac Iii Cement Mixing System","code_information":[{"code":"1602128","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602128","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"Rotavirus Vaccine, Pentavalent, 3 Dose Schedule, Live, For Oral Use Poc","code_information":[{"code":"20090680","type":"CDM"},{"code":"521","type":"RC"},{"code":"90680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":166}]}]},{"description":"29584 -Apply Multilay Comprs Arm/hand Er Tech","code_information":[{"code":"13529584","type":"CDM"},{"code":"450","type":"RC"},{"code":"29584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":290,"discounted_cash":290,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"Xr Manual Stress Application To Joint","code_information":[{"code":"36077071","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":276,"gross_charge":290,"discounted_cash":290,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"Antidiuretic Hormone Pspc","code_information":[{"code":"35084588P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84588","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":275,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"Cyclosporine, Whole Blood Pspc","code_information":[{"code":"35080158P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":275,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"24640-treat Elbow Dislocation Tech","code_information":[{"code":"14024640","type":"CDM"},{"code":"510","type":"RC"},{"code":"24640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":275,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"Kit Catheter Central Venous 7fr 3-lumen","code_information":[{"code":"1602077","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":275,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":165}]}]},{"description":"99281 Ed Medical Screening Examtech","code_information":[{"code":"13599281-GZ","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT","modifier":"GZ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GZ"],"minimum":101,"maximum":274,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"Acetamin, Quant Pspc","code_information":[{"code":"35080329P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":274,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"Lyme Disease Ab Pspc","code_information":[{"code":"35086618P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":274,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"Lactate","code_information":[{"code":"35083605","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":273,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"Testo, T & Fed Pspc","code_information":[{"code":"35084402FEDP","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":273,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"96402 Chemo Hormon Sq/im Charge","code_information":[{"code":"14596402","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":273,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"Ot Strapping, Elbow, Wrist Units","code_information":[{"code":"32029260-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"29260","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":100,"maximum":273,"gross_charge":287,"discounted_cash":287,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":164}]}]},{"description":"29505 Application Long Leg Splint Ed Charge","code_information":[{"code":"13529505","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"29540 Strapping Ankle/foot Ed Charge","code_information":[{"code":"13529540","type":"CDM"},{"code":"450","type":"RC"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"Work Reconditioning Chargework Reconditioning Charge","code_information":[{"code":"32097545-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97545","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"Cath Ultrathane Drain","code_information":[{"code":"1601499","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601499","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"10060 Drain Skin Abscess, Simple/single Charge","code_information":[{"code":"20010060","type":"CDM"},{"code":"521","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst Technical Charge","code_information":[{"code":"20010160","type":"CDM"},{"code":"521","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":272,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":163}]}]},{"description":"Clot Factor Viii Add On Charge 1","code_information":[{"code":"35085245P","type":"CDM"},{"code":"300","type":"RC"},{"code":"85245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":271,"gross_charge":285,"discounted_cash":285,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Clot Factor Viii Add On Charge 2","code_information":[{"code":"35085246P","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":271,"gross_charge":285,"discounted_cash":285,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Cutting Loop Electrode 24 Fr 90 Degrees","code_information":[{"code":"1601814","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601814","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":271,"gross_charge":285,"discounted_cash":285,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Roth Net Foreign Body","code_information":[{"code":"1600773","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600773","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":271,"gross_charge":285,"discounted_cash":285,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Tissue Process, Level V Pspc","code_information":[{"code":"35088307P","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":270,"gross_charge":284,"discounted_cash":284,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"23500 Closed Treatment Of Clavicluar Fracture; Without Manipulation","code_information":[{"code":"14023500","type":"CDM"},{"code":"510","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":270,"gross_charge":284,"discounted_cash":284,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Excision, Malignant Lesion Including Margins Face, .06 To 1.0 Cm","code_information":[{"code":"14011641","type":"CDM"},{"code":"510","type":"RC"},{"code":"11641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":270,"gross_charge":284,"discounted_cash":284,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Rpr S/n/ax/gen/trk 7.6-12.5 Cm â Clinic","code_information":[{"code":"20012004","type":"CDM"},{"code":"521","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":270,"gross_charge":284,"discounted_cash":284,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":162}]}]},{"description":"Beta 2 Transferrin Pspc","code_information":[{"code":"35086335P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":268,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":161}]}]},{"description":"11602-exci Malg Les Inc Marg, Trunk, Arm, Leg 1.1-2 Cm-sc Tech","code_information":[{"code":"14011602","type":"CDM"},{"code":"510","type":"RC"},{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":268,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":161}]}]},{"description":"Rom Walker Boot Xlg","code_information":[{"code":"1601510","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601510","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":268,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":161}]}]},{"description":"Walker Pro-rom Small","code_information":[{"code":"1601458","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601458","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":268,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":161}]}]},{"description":"Nitinol Bskt 3.0x90cm","code_information":[{"code":"1601543","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601543","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":267,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}]},{"description":"Leucovorin 10 Mg/ml50 Ml [Chas]","code_information":[{"code":"CP17640152376490118","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323063150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":98,"maximum":267,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carbofix Drill Bit 2.0x115mm Single Use Sterile","code_information":[{"code":"1602139","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602139","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":266,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}]},{"description":"Carbofix Drill Bit 2.5x115mm Single Use Sterile","code_information":[{"code":"1602140","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":266,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}]},{"description":"Carbofix Drill Bit 3.0x115mm Single Use Sterile","code_information":[{"code":"1602141","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":266,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}]},{"description":"K-wire 1.4mm Single Use, Sterile","code_information":[{"code":"1602138","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602138","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":266,"gross_charge":280,"discounted_cash":280,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":160}]}]},{"description":"Pt High Complex Units","code_information":[{"code":"31097163-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":98,"maximum":265,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":159}]}]},{"description":"Ertapenem 1 G Rec [Chas]","code_information":[{"code":"CP17640152376478293","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":97,"maximum":264,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":158}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"35080053","type":"CDM"},{"code":"301","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":263,"gross_charge":277,"discounted_cash":277,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":158}]}]},{"description":"96374 Iv Push Initialchas Ed Tech","code_information":[{"code":"13596374","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"Bone Cement","code_information":[{"code":"1601648","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601648","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"16000 Initial Treamtment Of Burnsed Tech","code_information":[{"code":"12516000","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"20043239","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"14043239","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"11104 Punch Bx Of Skin; Single Lesion-clinic","code_information":[{"code":"20011104","type":"CDM"},{"code":"521","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17640152543590763","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":262,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":157}]}]},{"description":"11310 Shave (Epi)dermal Lesion, Single, Face/ears/eyelids/nose/lips/mucous Membrane; Diam 0.5cm>","code_information":[{"code":"20011310","type":"CDM"},{"code":"521","type":"RC"},{"code":"11310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":260,"gross_charge":274,"discounted_cash":274,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":156}]}]},{"description":"Neg Press Wound Tx <50 Cmtech","code_information":[{"code":"10597605","type":"CDM"},{"code":"110","type":"RC"},{"code":"97605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"Post-vasectomy Sperm","code_information":[{"code":"35089310","type":"CDM"},{"code":"300","type":"RC"},{"code":"89310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"36590 Rem Tunneled Cvad W Po","code_information":[{"code":"14036590","type":"CDM"},{"code":"510","type":"RC"},{"code":"36590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"43270 Egd Lesion Ablation","code_information":[{"code":"12543270","type":"CDM"},{"code":"750","type":"RC"},{"code":"43270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"Trocar Endpth Xcel 5mm 150ml","code_information":[{"code":"1601754","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"14099204","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"Smpl Repair Of Sprfcl Wounds Of Face, Ears, Eyelids, Nose, Lips And Or Mms Less Than2.5 Cmtechnical","code_information":[{"code":"20012011","type":"CDM"},{"code":"521","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":258,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":155}]}]},{"description":"Cord Blood Eval Abo, Pspc","code_information":[{"code":"35086900CBP","type":"CDM"},{"code":"301","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Abo/rh(d) Pspc","code_information":[{"code":"35086900P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Dexamethasone Pspc","code_information":[{"code":"350DEXA","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Topiramate Pspc","code_information":[{"code":"35080201P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Remove Malig Lesion W/margins, Scalp, Neck, Hands, Feet, Genital; Diam 0.6 To 1.0 Cm Charge","code_information":[{"code":"14011621","type":"CDM"},{"code":"510","type":"RC"},{"code":"11621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"94640 Aerosol/vapor Inhal Trmt Charge","code_information":[{"code":"30094640","type":"CDM"},{"code":"412","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"46050incision Of Anal Abscessed Tech","code_information":[{"code":"13546050","type":"CDM"},{"code":"450","type":"RC"},{"code":"46050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Hsv Dna Direct Detection, Swab Pspc","code_information":[{"code":"35087529P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"Us Echo Doppler Complete","code_information":[{"code":"38093320","type":"CDM"},{"code":"483","type":"RC"},{"code":"93320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":257,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":154}]}]},{"description":"41010 Incision Of Lingual Frenum (Frenotomy)","code_information":[{"code":"14041010","type":"CDM"},{"code":"510","type":"RC"},{"code":"41010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Chas Sulfer Colloid","code_information":[{"code":"4020225","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Trocar Endpth Xcel 5mm","code_information":[{"code":"1601170","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601170","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Office/op New Visit Level 2 99202","code_information":[{"code":"20099202","type":"CDM"},{"code":"521","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Destruction (Eg, Laser/electro/cryo/chemosurgery/curettement), Of Warts; Up To 14 Lesions Charge","code_information":[{"code":"20017110","type":"CDM"},{"code":"521","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Fine Needle Biopsy/aspiration Charge","code_information":[{"code":"20010021","type":"CDM"},{"code":"521","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":256,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Mercury Add On Charge","code_information":[{"code":"35083825P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":255,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Xr Shoulder 1 View Left","code_information":[{"code":"36073020L-LT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":94,"maximum":255,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Xr Shoulder 1 View Right","code_information":[{"code":"36073020R-RT","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":94,"maximum":255,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Kit Continuous Nerve Block","code_information":[{"code":"1601598","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601598","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":255,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Subsequent Nursing Facility Care (History, Examination And Mdm Of Low Complexity","code_information":[{"code":"20099308-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99308","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":94,"maximum":255,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":153}]}]},{"description":"Tb Interferon Antigen Response (Quantiferon-tb Gold) Pspc","code_information":[{"code":"35086480P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":253,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":152}]}]},{"description":"Us Bladder W/ Residual","code_information":[{"code":"38051798","type":"CDM"},{"code":"402","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":253,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":152}]}]},{"description":"Cut Loop Elec 24 Fr 30deg","code_information":[{"code":"1600300","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":253,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":152}]}]},{"description":"15002-wound Prep Trk/arm/leg Sc Tech","code_information":[{"code":"14015002","type":"CDM"},{"code":"510","type":"RC"},{"code":"15002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":251,"gross_charge":264,"discounted_cash":264,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"D-dimer","code_information":[{"code":"35085379","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"H Pylori Ag, Stool Pspc","code_information":[{"code":"35087338P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"Tacrolimus Pspc","code_information":[{"code":"35080197P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"29515 Apply Lower Leg Splint Calf-footed Tech","code_information":[{"code":"13529515","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"Brace Economy Rom Long","code_information":[{"code":"1601307","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"Brace Economy Rom Short","code_information":[{"code":"1601406","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601406","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"11301 Shave (Epi)dermal Lesion, Single, Trunk, Arms Or Legs; Diam 0.6 To 1.0 Cm Charge","code_information":[{"code":"20011301","type":"CDM"},{"code":"521","type":"RC"},{"code":"11301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":250,"gross_charge":263,"discounted_cash":263,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":150}]}]},{"description":"12002repair Simple  Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.6 Cm To 7.5 Cm Charge","code_information":[{"code":"20012002","type":"CDM"},{"code":"521","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":249,"gross_charge":262,"discounted_cash":262,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}]},{"description":"Oseltamivir 6 Mg/ml60 Ml Rec[chas]","code_information":[{"code":"CP17640152376521652","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180067801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":92,"maximum":249,"gross_charge":262,"discounted_cash":262,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Benzo Conf  Pspc","code_information":[{"code":"35080154P","type":"CDM"},{"code":"301","type":"RC"},{"code":"CP35080154P","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":248,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}]},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"35080053P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":248,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}]},{"description":"Protein S, Functional (Activity) (Rps) Pspc","code_information":[{"code":"35085306P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":248,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}]},{"description":"Selenium, Serum (Rps) Pspc","code_information":[{"code":"350SELE","type":"CDM"},{"code":"301","type":"RC"},{"code":"84255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":248,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}]},{"description":"Diazepam 10 Mg Gel[chas]","code_information":[{"code":"CP17640152376462807","type":"CDM"},{"code":"250","type":"RC"},{"code":"00187065820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":91,"maximum":248,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":149}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"C1 Est Inhib Funct Pspc","code_information":[{"code":"35086161P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Pelvic Sling Ii, Large","code_information":[{"code":"1601807","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601807","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Pelvic Sling Ii, Standard","code_information":[{"code":"1601806","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601806","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"14055700","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Pentacelclinic","code_information":[{"code":"20090698","type":"CDM"},{"code":"521","type":"RC"},{"code":"90698","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Biopsy of prostate gland","code_information":[{"code":"CP17640152543607726","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":247,"gross_charge":260,"discounted_cash":260,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"B Lymphocyte Count Pspc","code_information":[{"code":"35086355M","type":"CDM"},{"code":"302","type":"RC"},{"code":"86355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Cd4 And Cd8 Cell Counts Pspc","code_information":[{"code":"35086360M","type":"CDM"},{"code":"302","type":"RC"},{"code":"86360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Nk Lymphocyte Count Pspc","code_information":[{"code":"35086357M","type":"CDM"},{"code":"302","type":"RC"},{"code":"86357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"T Lymphocyte Count Pspc","code_information":[{"code":"35086359M","type":"CDM"},{"code":"302","type":"RC"},{"code":"86359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Ot Sensory Integration, 15 Min","code_information":[{"code":"32097533-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"30300 Removal Fb Intranasal","code_information":[{"code":"14030300","type":"CDM"},{"code":"510","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"11042 Debride Skin/soft Tissue Charge","code_information":[{"code":"20011042","type":"CDM"},{"code":"521","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":246,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":148}]}]},{"description":"Alcohol1","code_information":[{"code":"35080320","type":"CDM"},{"code":"300","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":245,"gross_charge":258,"discounted_cash":258,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":147}]}]},{"description":"Therapeutic Phlebotomy 3","code_information":[{"code":"35099195","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":245,"gross_charge":258,"discounted_cash":258,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":147}]}]},{"description":"99195 Phelbotomy Charge","code_information":[{"code":"14599195","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":245,"gross_charge":258,"discounted_cash":258,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":147}]}]},{"description":"Anti-chromatin Abs Add On Charge","code_information":[{"code":"35086235CHR","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Anti-rnp Abs Add On Charge","code_information":[{"code":"35086235RNP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Free T3","code_information":[{"code":"35084481","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Tobramycin Trough Pspc","code_information":[{"code":"35080200P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Kit Chest Tube Disposable","code_information":[{"code":"1601932","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601932","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"28660 Closed Treatment Of Interphalangeal Joint Dislocation; Without Anesthesia","code_information":[{"code":"20028660","type":"CDM"},{"code":"521","type":"RC"},{"code":"28660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":244,"gross_charge":257,"discounted_cash":257,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Renin Pspc","code_information":[{"code":"35084244P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":243,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Anti-mullerian Hormone Pspc","code_information":[{"code":"35083520A","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":243,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Destruction Malignant Lesion 1.12.0cm","code_information":[{"code":"14017282","type":"CDM"},{"code":"510","type":"RC"},{"code":"17282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":243,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Suture #2 Fiberlink S/closed Loop 26 Blue","code_information":[{"code":"1601912","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601912","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":243,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":146}]}]},{"description":"Chlamydia Pneumoniae Ab Pspc Add-on 1","code_information":[{"code":"35086631P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"Amino Acid Quant, Urine Pspc","code_information":[{"code":"35082139UP","type":"CDM"},{"code":"301","type":"RC"},{"code":"82139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"Centromere Pspc","code_information":[{"code":"35082516CP","type":"CDM"},{"code":"301","type":"RC"},{"code":"82523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"Rbc Antigen Screen Arc","code_information":[{"code":"35086905ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"Vedolizumab Level","code_information":[{"code":"35080280P","type":"CDM"},{"code":"302","type":"RC"},{"code":"80280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"12013 Rpr Smpl Face 2.6-5.0cm","code_information":[{"code":"20012013","type":"CDM"},{"code":"521","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":242,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"88341 Immunohistochemistry","code_information":[{"code":"35088341UNMC","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":241,"gross_charge":254,"discounted_cash":254,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":145}]}]},{"description":"Pain Management Panel, Screen W/ Reflex Pspc","code_information":[{"code":"35080307P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":240,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":144}]}]},{"description":"Typhoid Vaccine, Vi Capsular Polysaccharide (Vicps) Im Use","code_information":[{"code":"20090691","type":"CDM"},{"code":"521","type":"RC"},{"code":"90691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":240,"gross_charge":253,"discounted_cash":253,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":144}]}]},{"description":"Cutter Reload Unit Proximate","code_information":[{"code":"1601854","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601854","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":239,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":144}]}]},{"description":"Us Abdomen Limitedreport Bce","code_information":[{"code":"14576705-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Destruct Of Lession(s), Penis, Simple; Cryosurgery Charge","code_information":[{"code":"14054056","type":"CDM"},{"code":"510","type":"RC"},{"code":"54056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Chas Hdp Oxidronate","code_information":[{"code":"370A9561","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Chas Mdp-medronate","code_information":[{"code":"370A9503","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Carboplatin Inj  10mg/ml45 Ml [Chas]","code_information":[{"code":"CP17640152376458149","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Etoposide 20 Mg/ml25 Ml Sol [Chas]","code_information":[{"code":"CP17640152376475006","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":238,"gross_charge":251,"discounted_cash":251,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Switching Stick 2.6mm X 305mm","code_information":[{"code":"1601674","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601674","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Drill Bit (Ao)","code_information":[{"code":"1602005","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"Maxcore Biopsy Instrument","code_information":[{"code":"1600601","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600601","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":238,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":143}]}]},{"description":"G0239 Rt 2+ Patients Charge","code_information":[{"code":"300G0239","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":237,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":142}]}]},{"description":"Opiate Conf, Gc-ms Pspc","code_information":[{"code":"35080361P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":236,"gross_charge":248,"discounted_cash":248,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":141}]}]},{"description":"Ofloxacin Otic 0.3% Soln [Chas]","code_information":[{"code":"CP17640152376522041","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505036301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":235,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":141}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Immediate Spin","code_information":[{"code":"35086920","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":234,"gross_charge":246,"discounted_cash":246,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"62328dx Lmbr Spi Pnxr W/fluor/ctsurg Tech","code_information":[{"code":"12562328","type":"CDM"},{"code":"360","type":"RC"},{"code":"62328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":234,"gross_charge":246,"discounted_cash":246,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"St Fees W Cine Or Video Charge","code_information":[{"code":"33092612-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92612","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":86,"maximum":234,"gross_charge":246,"discounted_cash":246,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"28010-incision Of Toe Tendon-sc Tech","code_information":[{"code":"14028010","type":"CDM"},{"code":"510","type":"RC"},{"code":"28010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":233,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"20043235","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":233,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"14043235","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":233,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17640152543592191","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":233,"gross_charge":245,"discounted_cash":245,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":140}]}]},{"description":"In Situ Hybridization, Per Spec Unmc Pspc","code_information":[{"code":"35088364UNMC","type":"CDM"},{"code":"300","type":"RC"},{"code":"88364","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"H Pylori Iga Add On","code_information":[{"code":"35086677A","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"H Pylori Igm Add On","code_information":[{"code":"35086677M","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"Alpha-1 Antitrypsin, Feces Pspc","code_information":[{"code":"350ALPHA","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"Helicobacter Pylori Antibody, Igg (Rps) Pspc","code_information":[{"code":"35086677G","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"99349-level 3 Home Visit","code_information":[{"code":"20099349","type":"CDM"},{"code":"521","type":"RC"},{"code":"99349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":231,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":139}]}]},{"description":"Legionella Ag, Urn Pspc","code_information":[{"code":"35087449P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":230,"gross_charge":242,"discounted_cash":242,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":138}]}]},{"description":"11305 Shave (Epi)dermal Lesion, Single, Scalp, Neck, Hands, Feet, Genital; Diam 0.5 Cm > Charge","code_information":[{"code":"20011305","type":"CDM"},{"code":"521","type":"RC"},{"code":"11305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":230,"gross_charge":242,"discounted_cash":242,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":138}]}]},{"description":"81376","code_information":[{"code":"35081376P","type":"CDM"},{"code":"302","type":"RC"},{"code":"81376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":229,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"96523 Port Central Line Flush Charge","code_information":[{"code":"14596523","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":229,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Inflation Device","code_information":[{"code":"1600500","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600500","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":229,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Cardiolipin Abs, Iga, M, G Pspc","code_information":[{"code":"35086147P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":228,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Epstein Barr Virus Dna Quantitative, Blood (Rps) Pspc","code_information":[{"code":"35087799P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":228,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"51705-change Of Cystomy Tube; Simple Charge- Sc Tech","code_information":[{"code":"14051705","type":"CDM"},{"code":"510","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":228,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Needle Disp Injetak Adj 70cm","code_information":[{"code":"1601980","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601980","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":228,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Sensor Ptfe-nitinol Guidewire","code_information":[{"code":"1602109","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":228,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":137}]}]},{"description":"Biopsy Endometrial Charge","code_information":[{"code":"20058100","type":"CDM"},{"code":"521","type":"RC"},{"code":"58100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":227,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"20610 Arthrocentesis Major Joint, Shoulder, Hip, Knee Charge","code_information":[{"code":"20020610","type":"CDM"},{"code":"521","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":227,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"69209-remove Impacted Ear Wax Uni-er Tech","code_information":[{"code":"13569209","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":226,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"Kid Stone Ur Cmbo Vg Sat Pspc","code_information":[{"code":"35082360P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":226,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"Vancomycin Trough Pspc","code_information":[{"code":"35080202T","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":226,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"Iv Push Addl Diff Drugsc","code_information":[{"code":"14596375","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":226,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"Strapping; Unna Boot","code_information":[{"code":"10529580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":226,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":136}]}]},{"description":"Shaver Blade Angled 4.0mm Atrhoscopic","code_information":[{"code":"1601667","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601667","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":225,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":135}]}]},{"description":"Brace Kuhl Shield Knee Md","code_information":[{"code":"1600116","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":225,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":135}]}]},{"description":"Gelfoam Size 100","code_information":[{"code":"1600444","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600444","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":224,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":135}]}]},{"description":"Hexagonal Pl Neutral Pspc","code_information":[{"code":"35085598P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"35080048","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"92014 Opthalmology 2 Charge","code_information":[{"code":"145G0463","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"Iv Infusion Sequential  Addl Hour Tech Chg","code_information":[{"code":"14596367","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"Forcep Flexcysto Graspiing Single Use","code_information":[{"code":"1601979","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601979","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"11300 Shave (Epi)dermal Lesion, Single, Trunk, Arms Or Legs; Diam 0.5 Cm > Charge","code_information":[{"code":"20011300","type":"CDM"},{"code":"521","type":"RC"},{"code":"11300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":223,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":134}]}]},{"description":"Ck Iso, Serum Pspc","code_information":[{"code":"35082552P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"Reference Lab Pspc","code_information":[{"code":"35083021P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"Test Name Pspc","code_information":[{"code":"35082728P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"24075exc Arm/elbow Les Sc < 3 Cmsc Tech","code_information":[{"code":"14024075","type":"CDM"},{"code":"510","type":"RC"},{"code":"24075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection","code_information":[{"code":"14010140","type":"CDM"},{"code":"510","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"Disposable, Punch Swivelock Anchor","code_information":[{"code":"1601993","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"11200 Removal Of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up To & W/15 Lesions Charge","code_information":[{"code":"20011200","type":"CDM"},{"code":"521","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"29075 Applic, Cast; Elbow To Finger (Short Arm) Charge","code_information":[{"code":"20029075","type":"CDM"},{"code":"521","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"69200 Removal Foreign Body From External Auditory Canal; Without General Anesthesia Charge","code_information":[{"code":"20069200","type":"CDM"},{"code":"521","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"Immune Globulin Iv-sq 10% Sol1 Gm/10 Ml  [Chas]","code_information":[{"code":"CP17640152376494820","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":222,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Babesia Microti Abs Igm Pspc","code_information":[{"code":"35086753P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":221,"gross_charge":233,"discounted_cash":233,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"29530 Strapping Knee Ed Tech","code_information":[{"code":"13529530","type":"CDM"},{"code":"450","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":221,"gross_charge":233,"discounted_cash":233,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"94667 Manipul Chest Wall Iiniti Charge","code_information":[{"code":"30094667","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":221,"gross_charge":233,"discounted_cash":233,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":133}]}]},{"description":"13122-cmplx Rpr S/a/l Addl 5 Cm/> Tech","code_information":[{"code":"13513122","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":220,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"96375 Iv Push Addl Diff Drugchas Ed Tech","code_information":[{"code":"13596375","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":220,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"5-hiaa Pspc","code_information":[{"code":"35083497P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":220,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Gent, Peak Pspc","code_information":[{"code":"35080170P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":220,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Lipoprotein (A) Pspc","code_information":[{"code":"35083695P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":220,"gross_charge":232,"discounted_cash":232,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Alpha-1 Phenotype Pspc","code_information":[{"code":"35082104P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"T-transglutaminase Iga Pspc","code_information":[{"code":"35083516TTP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"96367 Iv Meds 2nd Med Sequentialed Tech [Chas]","code_information":[{"code":"13596367","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Rom Plus","code_information":[{"code":"35084112","type":"CDM"},{"code":"300","type":"RC"},{"code":"84112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Rapid Rsv 1","code_information":[{"code":"35087807","type":"CDM"},{"code":"301","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"33285insj Subq Car Rhythm Mntr- Surg Tech","code_information":[{"code":"12533285","type":"CDM"},{"code":"360","type":"RC"},{"code":"33285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":132}]}]},{"description":"Varicella Zoster Virus Dna, Swab Pspc","code_information":[{"code":"35087798SWP","type":"CDM"},{"code":"302","type":"RC"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":131}]}]},{"description":"Guidewire Nitinol St Tip","code_information":[{"code":"1600459","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600459","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":219,"gross_charge":230,"discounted_cash":230,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":131}]}]},{"description":"Ckmb","code_information":[{"code":"35082553","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":218,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":131}]}]},{"description":"Hcg Quantitative","code_information":[{"code":"35084702","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":218,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":131}]}]},{"description":"Pt Moderate Complex Units","code_information":[{"code":"31097162-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":218,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":131}]}]},{"description":"Electrode One-step Adult","code_information":[{"code":"1601786","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601786","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":217,"gross_charge":228,"discounted_cash":228,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":130}]}]},{"description":"Hantavirus Abs Pspc","code_information":[{"code":"35086790P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"U24 Cortisol, Free Pspc","code_information":[{"code":"35082350P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"Fetal Contract Stress Test","code_information":[{"code":"12059020","type":"CDM"},{"code":"720","type":"RC"},{"code":"59020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"36591 Port Draw Chargeoutpt","code_information":[{"code":"14536591","type":"CDM"},{"code":"761","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"51701 Insertion Of Non-indwelling Bladder Catheter (Eg, Straight Catheterization For Residual Urine)","code_information":[{"code":"14551701","type":"CDM"},{"code":"761","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"Tape Labral","code_information":[{"code":"1601948","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601948","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"14064483","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"10040 Acne Surgery Eg, Marsup, Opening Or Removal Of Multiple Milia, Comedones, Cysts, Pustules","code_information":[{"code":"20010040","type":"CDM"},{"code":"521","type":"RC"},{"code":"10040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":216,"gross_charge":227,"discounted_cash":227,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"Cortisol, Serum Free (Rps) Pspc","code_information":[{"code":"35082530P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":215,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"20610-drain/inj Joint/bursa W/o Us","code_information":[{"code":"10520610","type":"CDM"},{"code":"510","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":215,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}]},{"description":"Pralidoxime 1 Gm Inj  [Chas]","code_information":[{"code":"CP17640152376531684","type":"CDM"},{"code":"250","type":"RC"},{"code":"60977014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":79,"maximum":215,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":129}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cord Blood Eval Dat, Pspc","code_information":[{"code":"35086880CBP","type":"CDM"},{"code":"301","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":214,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"11620 Remove Malig Lesion W/margins, Scalp, Neck, Hands, Feet, Genital; Diam 0.5 Cm > Charge","code_information":[{"code":"14011620","type":"CDM"},{"code":"510","type":"RC"},{"code":"11620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":214,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"64510n Block Stellate Ganglionsurg Tech","code_information":[{"code":"12564510","type":"CDM"},{"code":"360","type":"RC"},{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":214,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"C.diff Toxin Eia","code_information":[{"code":"35087324C","type":"CDM"},{"code":"302","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":213,"gross_charge":224,"discounted_cash":224,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"51701 Insert Bladder Catheter -Ed Tech","code_information":[{"code":"13551701","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":213,"gross_charge":224,"discounted_cash":224,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"Bb-tak, Mtp","code_information":[{"code":"1602000","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":213,"gross_charge":224,"discounted_cash":224,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"29125 Application Of Short Arm Splint; Static","code_information":[{"code":"20029125","type":"CDM"},{"code":"521","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":213,"gross_charge":224,"discounted_cash":224,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":128}]}]},{"description":"Aspergillus Galactomannan Ag, Serum (Arup) Pspc","code_information":[{"code":"35087305P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":212,"gross_charge":223,"discounted_cash":223,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":127}]}]},{"description":"Electrode One-step Pediatric","code_information":[{"code":"1601785","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601785","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":211,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":127}]}]},{"description":"Silverlon Island Wound Dressing 4x10","code_information":[{"code":"1602126","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":211,"gross_charge":222,"discounted_cash":222,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":127}]}]},{"description":"Immunofixation Serum, Pspc","code_information":[{"code":"35086334P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":210,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":126}]}]},{"description":"Tubing Crossflow Inflow Cassette","code_information":[{"code":"1602049","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602049","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":210,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":126}]}]},{"description":"64405 Nerve Block Inj Occipital-clinic","code_information":[{"code":"20064405","type":"CDM"},{"code":"521","type":"RC"},{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":209,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":125}]}]},{"description":"29065 Applic, Cast; Shoulder To Hand (Long Arm) Charge-clinic","code_information":[{"code":"20029065","type":"CDM"},{"code":"521","type":"RC"},{"code":"29065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":209,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":125}]}]},{"description":"Hcg Qualitative, Serum 1","code_information":[{"code":"35084703","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":208,"gross_charge":219,"discounted_cash":219,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":125}]}]},{"description":"Destruct Malig Lesion, Face, Ears, Eyelids, Nose, Lips, Mm; ; 0.6-1.0 Cm  Technical Charge","code_information":[{"code":"14017281","type":"CDM"},{"code":"510","type":"RC"},{"code":"17281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":208,"gross_charge":219,"discounted_cash":219,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":125}]}]},{"description":"Plate Tubular One-third","code_information":[{"code":"1601887","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601887","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":208,"gross_charge":219,"discounted_cash":219,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":125}]}]},{"description":"Phenobarbitol Pspc","code_information":[{"code":"35080184P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":207,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":124}]}]},{"description":"Star Sleeve","code_information":[{"code":"1601665","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601665","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":207,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":124}]}]},{"description":"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm","code_information":[{"code":"14017262","type":"CDM"},{"code":"510","type":"RC"},{"code":"17262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":207,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":124}]}]},{"description":"11102 Tangential Bx Of Skin (Eg, Shave, Scoop, Saucerize, Curette)-clinic Pro","code_information":[{"code":"20011102","type":"CDM"},{"code":"521","type":"RC"},{"code":"11102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":207,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":124}]}]},{"description":"Copper, Serum Pspc","code_information":[{"code":"35082525S","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":205,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Copper, Ur 24hr Pspc","code_information":[{"code":"35082525P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":205,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Kidney function panel test","code_information":[{"code":"35080069","type":"CDM"},{"code":"301","type":"RC"},{"code":"80069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":205,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Chemo Iv Infuse Ea Add Hr","code_information":[{"code":"14596415","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76,"maximum":205,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"C.diff Toxin Eia Pspc","code_information":[{"code":"35087324","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Cytomegalovirus Amp Pr Pspc","code_information":[{"code":"35087496P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Enterovirus Amp Pr Pspc","code_information":[{"code":"35087498P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Herpes Virus-6 Amp Pr Pspc","code_information":[{"code":"35087532P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Strep Group B Amp Pr Pspc","code_information":[{"code":"35087653P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Frz Plasma Cpd Frozen<=24h","code_information":[{"code":"350P9017","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"11740 Evacuation Subungual Hematoma Techfee","code_information":[{"code":"13511740","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Crossmatch, Is Arc","code_information":[{"code":"35086920ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Ins Gr Ftr I, Somato C Pspc","code_information":[{"code":"35084305P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"U24 17 Ketosteroids Pspc","code_information":[{"code":"35083586P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83586","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"12001 Repair Simple  Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.5 Cm > Charge","code_information":[{"code":"20012001","type":"CDM"},{"code":"521","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}]},{"description":"Daptomycin 500 Mg Vial[chas]","code_information":[{"code":"CP17640152376460459","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":204,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":123}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Angio Convert E Pspc","code_information":[{"code":"35082164P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Picc Power","code_information":[{"code":"14536592","type":"CDM"},{"code":"761","type":"RC"},{"code":"36592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Insufflation/access Needl","code_information":[{"code":"1600505","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600505","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Orthodics Lynoc L620","code_information":[{"code":"1600671","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600671","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Screw Cortical 3.5mm, Titanium","code_information":[{"code":"1601924","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Walker Pro-rom Medium","code_information":[{"code":"1601457","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601457","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"Nsg Facility Annual","code_information":[{"code":"20099318","type":"CDM"},{"code":"525","type":"RC"},{"code":"99318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":203,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":122}]}]},{"description":"88360 Morphometric Analysis Unmc","code_information":[{"code":"35088360UNMC","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":202,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Sputum Culture","code_information":[{"code":"35087070S","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":202,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Chas Pertechnetate","code_information":[{"code":"4020228","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":202,"gross_charge":213,"discounted_cash":213,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"H. Pylori Urea Breath Test, Pspc","code_information":[{"code":"35083013P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"H.pylori Urea Breath Test, Ped Pspc","code_information":[{"code":"35083013PP","type":"CDM"},{"code":"301","type":"RC"},{"code":"83013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Testo, Free Dir  Pspc","code_information":[{"code":"35084402P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Excision, Benign Lesion, Trunk 0.6-1.0 Cm","code_information":[{"code":"14011401","type":"CDM"},{"code":"510","type":"RC"},{"code":"11401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Incision And Removal Of Foreign Body, Subcutaneous","code_information":[{"code":"14010120","type":"CDM"},{"code":"510","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"Catheter 6fr Filiform Spiral","code_information":[{"code":"1601571","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601571","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":201,"gross_charge":212,"discounted_cash":212,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":121}]}]},{"description":"B. Henselae Igg-cat Scratch Pspc","code_information":[{"code":"35086611P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Ca 125 Pspc","code_information":[{"code":"35086304P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Phenytoin Pspc","code_information":[{"code":"35080185P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"20605-drain/inj Joint/bursa W/o Us","code_information":[{"code":"10520605","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Suture Passer","code_information":[{"code":"1601398","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601398","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Diphth/hepb/pertussis,acel/polio/tetanus Vaccine Poc","code_information":[{"code":"20090723","type":"CDM"},{"code":"521","type":"RC"},{"code":"90723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"29085 Applic, Cast; Hand & Lower Forearm (Gauntlet) Charge","code_information":[{"code":"20029085","type":"CDM"},{"code":"521","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":211,"discounted_cash":211,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":".Gluc Fasting","code_information":[{"code":"35082951","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":200,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Mmr Measles/mumps/rubella Virus Vaccine Poc","code_information":[{"code":"20090707-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90707","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":74,"maximum":200,"gross_charge":210,"discounted_cash":210,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":120}]}]},{"description":"Irinotecan 20 Mg/ml5 Ml [Chas]","code_information":[{"code":"CP17640152376496777","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"86353-lymphocyte Proliferation (Rps) Pspc","code_information":[{"code":"35086353P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}]},{"description":"Round Bur 12-flute 4.0mm","code_information":[{"code":"1601669","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601669","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}]},{"description":"Pt Low Complex Units","code_information":[{"code":"31097161-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}]},{"description":"Handle Probe Plus Ii","code_information":[{"code":"1600462","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600462","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}]},{"description":"Ceftriaxone 2 Gm Vial[chas]","code_information":[{"code":"CP17640152376457365","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":198,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":119}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Prot Electro, Ur Rndm Pspc","code_information":[{"code":"35084166P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":197,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":118}]}]},{"description":"17272 Dest Malig Scalp 1.1-2.0 Clinic Charge","code_information":[{"code":"14017272","type":"CDM"},{"code":"510","type":"RC"},{"code":"17272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":197,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":118}]}]},{"description":"I&d Pilonidal Cyst; Simple Tech Chg","code_information":[{"code":"14010080","type":"CDM"},{"code":"510","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":197,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":118}]}]},{"description":"Ligaclip Multi-clip Applier (Mca)","code_information":[{"code":"1601733","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601733","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":197,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":118}]}]},{"description":"Walker R.o.m.  Large","code_information":[{"code":"1601459","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601459","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":197,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":118}]}]},{"description":"Barrel Bur 12-flute 4.0mm","code_information":[{"code":"1601668","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601668","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Bowl Cement Mixing","code_information":[{"code":"1601650","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601650","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Aggressive Plus Shaver Bl","code_information":[{"code":"1600026","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Airvo A/s Tube Chmb Kit","code_information":[{"code":"1601952","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601952","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Applier Ligaclip Mca Large","code_information":[{"code":"1601858","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601858","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Applier Ligaclip Mca Med Long","code_information":[{"code":"1601857","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601857","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Chest Drain Pump","code_information":[{"code":"1601271","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601271","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Disposab Grasping Forcep","code_information":[{"code":"1600312","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Inflatable Donut Pessary","code_information":[{"code":"1601560","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601560","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Fluorouracil 50 Mg/ml100 Ml [Chas]","code_information":[{"code":"CP17640152376489649","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":196,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Silver, Whole Blood (Arup Via Rps) Pspc","code_information":[{"code":"35083789P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":195,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Surg Recovery Phase Ii Charge","code_information":[{"code":"125009","type":"CDM"},{"code":"710","type":"RC"},{"code":"CP125009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":195,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Biopsy Penis","code_information":[{"code":"14054100","type":"CDM"},{"code":"510","type":"RC"},{"code":"54100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":195,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"20605 Arthrocentesis Intermed Joint, Wrist, Elbow, Ankle Charge","code_information":[{"code":"20020605","type":"CDM"},{"code":"521","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":195,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"98929  Omt 9-10 Body Regions-clinic","code_information":[{"code":"20098929","type":"CDM"},{"code":"521","type":"RC"},{"code":"98929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":195,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":117}]}]},{"description":"Alk P, Bone Spec Pspc","code_information":[{"code":"35084080P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":194,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Pt Evaluation Chargeevaluation Charge","code_information":[{"code":"CP17640151596949651","type":"CDM"},{"code":"CP17640151596949651","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":194,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Catheter Phillips Follower 16fr","code_information":[{"code":"1601847","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601847","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":194,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Catheter Phiwps 18fr","code_information":[{"code":"1601573","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":194,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Nsg Facility Care Init 25 Min","code_information":[{"code":"20099304-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99304","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":71,"maximum":194,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Ana Panel, Individual Tests Pspc","code_information":[{"code":"35086235P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":193,"gross_charge":203,"discounted_cash":203,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":116}]}]},{"description":"Blood test, lipids","code_information":[{"code":"35080061","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Prolactin Pspc","code_information":[{"code":"35084146P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"35084443","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Vanc Peak Pspc","code_information":[{"code":"35080202P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Blade Dual Cut","code_information":[{"code":"1601653","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601653","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Iv Push Same  Drug Add On Tech Chg","code_information":[{"code":"14596376","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"14062323","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Paclitaxel 6 Mg/ml16.7 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376532775","type":"CDM"},{"code":"250","type":"RC"},{"code":"61703034222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":192,"gross_charge":202,"discounted_cash":202,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"U24 Catecholamines Pspc","code_information":[{"code":"35084585P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":191,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Throat Culture","code_information":[{"code":"35087070T","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":191,"gross_charge":201,"discounted_cash":201,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":115}]}]},{"description":"Hepatitis Panel, Acute (Rps) Pspc","code_information":[{"code":"35080074P","type":"CDM"},{"code":"302","type":"RC"},{"code":"80074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":190,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":114}]}]},{"description":"Phencyclidine (Pcp) Confirmation/quantitationurine (Rps) Pspc","code_information":[{"code":"350PCP","type":"CDM"},{"code":"301","type":"RC"},{"code":"83992","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":190,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":114}]}]},{"description":"Shaver Blade 4.0mm Arthroscopic","code_information":[{"code":"1601666","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601666","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":190,"gross_charge":200,"discounted_cash":200,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":114}]}]},{"description":"30300- Remove Nasal Foreign Body -Ed Tech","code_information":[{"code":"13530300","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":189,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"Flosteady Arthio Pump Tub","code_information":[{"code":"1600420","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":189,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"90707 Mmr Measles/mumps/rubella Vacc [Chas]","code_information":[{"code":"20090707","type":"CDM"},{"code":"521","type":"RC"},{"code":"90707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":189,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"Erythropoietin (Rps) Pspc","code_information":[{"code":"35082668P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":188,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"Estradiol Pspc","code_information":[{"code":"35082670P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":188,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"Blade Agrressive Plus Cutter 4.0mm X 125mm","code_information":[{"code":"1602048","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":188,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":113}]}]},{"description":"G0010-admin Hepatitis B Vaccine-tech","code_information":[{"code":"105G0010","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":187,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Liver function blood test","code_information":[{"code":"35080076","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":187,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Total Knee Plus Iii Pack","code_information":[{"code":"1602132","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602132","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":187,"gross_charge":197,"discounted_cash":197,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Deamidated Gliadin Abs, Iga Pspc","code_information":[{"code":"35083516DGAP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Complement, Total, Pspc","code_information":[{"code":"35086162P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Cardiolipin Ab, Iga Rps","code_information":[{"code":"35086147A","type":"CDM"},{"code":"305","type":"RC"},{"code":"86147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Nortriptyline, Qt Pspc","code_information":[{"code":"35080335P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Theophylline Pspc","code_information":[{"code":"35080198P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"Anaerobic Culture","code_information":[{"code":"35087075","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"31233-nasal/sinus Endoscopy Dx-sc Tech","code_information":[{"code":"14031233","type":"CDM"},{"code":"510","type":"RC"},{"code":"31233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"51702-insert Foley Cathsc Tech","code_information":[{"code":"14051702","type":"CDM"},{"code":"510","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":186,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":112}]}]},{"description":"29105 Apply Long Arm Splint Profee","code_information":[{"code":"20029105","type":"CDM"},{"code":"521","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":185,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":111}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"35084154P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":184,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":111}]}]},{"description":"96366 Iv Meds Ea Addl Hrmed Ther","code_information":[{"code":"14596366","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":184,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":111}]}]},{"description":"Office/outpatient Visit Level 3 Established99213","code_information":[{"code":"20099213-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":68,"maximum":184,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":111}]}]},{"description":"Leucovorin 350 Mg Rec [Chas]","code_information":[{"code":"CP17640152376499292","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":68,"maximum":184,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":111}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Parathyroid Hormone Related Peptide Pspc","code_information":[{"code":"35082397RP","type":"CDM"},{"code":"301","type":"RC"},{"code":"82397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":183,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":110}]}]},{"description":"Bur Round 6-flute 3.5mm","code_information":[{"code":"1601796","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601796","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":183,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":110}]}]},{"description":"Glidewire 0.038  St Tip Reg Body,3cm","code_information":[{"code":"1602063","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":183,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":110}]}]},{"description":"45335sigmoidoscopy W/ Submuc Injsurg Tech","code_information":[{"code":"12545335","type":"CDM"},{"code":"360","type":"RC"},{"code":"45335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":182,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":109}]}]},{"description":"90632 Hepatitis A Adult Vaccine [Chas]","code_information":[{"code":"20090632","type":"CDM"},{"code":"521","type":"RC"},{"code":"90632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":181,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":109}]}]},{"description":"96376 Iv Push Addl Same Drug Ed Tech","code_information":[{"code":"13596376","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":181,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"35084443P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":181,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Docetaxel 20 Mg/ml Sol [Chas]","code_information":[{"code":"CP17640152376470657","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021024501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":181,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"96366 Iv Meds Ea Addl Hred Tech [Chas]","code_information":[{"code":"13596366","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Cea Ag Pspc","code_information":[{"code":"35082378P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Glucose-6-pd, Quant Pspc","code_information":[{"code":"35082955P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Lipase Level","code_information":[{"code":"35083690","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Mycoplasma Pneumoniae Abs Pspc","code_information":[{"code":"35086738P","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Val Acid, (Depak) Pspc","code_information":[{"code":"35080164P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Cont Gluc Mntr Pt Prov Eqp-tech","code_information":[{"code":"17095249","type":"CDM"},{"code":"942","type":"RC"},{"code":"95249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Destruction Premalignant Lesions, 15 Or More Lesions Technical Charge","code_information":[{"code":"14017004","type":"CDM"},{"code":"510","type":"RC"},{"code":"17004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Dnu Cognitive Skills Development Charges St","code_information":[{"code":"33097127-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"97127","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Wound Vac","code_information":[{"code":"1601783","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601783","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"29505 Apply Long Leg Splintclinic","code_information":[{"code":"20029505","type":"CDM"},{"code":"521","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":180,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":108}]}]},{"description":"Blade Sagittal","code_information":[{"code":"1601655","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601655","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":179,"gross_charge":188,"discounted_cash":188,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Arsenic Add On Charge","code_information":[{"code":"35082175P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Oxalate, 24-hr Ur Pspc","code_information":[{"code":"35083945P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Serotonin","code_information":[{"code":"35084260P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Selective Debridement Addition Charge","code_information":[{"code":"31097598-GP","type":"CDM"},{"code":"421","type":"RC"},{"code":"97598","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"33285 Cardiac Monitor Insert-tech","code_information":[{"code":"14033285","type":"CDM"},{"code":"761","type":"RC"},{"code":"33285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Surgical Skin Closure Device","code_information":[{"code":"1601940","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":178,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":107}]}]},{"description":"Drugs Of Abuse 9 Panel, Serum/plasma, Rps (Pspc)","code_information":[{"code":"35080307RPS","type":"CDM"},{"code":"301","type":"RC"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Ic Influenza A,b","code_information":[{"code":"35087502","type":"CDM"},{"code":"302","type":"RC"},{"code":"87502","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Influenza A&b 1","code_information":[{"code":"35087804","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"17264-destruction Of Malignant Lesion, Trunk, Arms, Or Legs; Lesion Diameter 3.1 To 4.0 Cm","code_information":[{"code":"14017264","type":"CDM"},{"code":"510","type":"RC"},{"code":"17264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst; Technical Charge","code_information":[{"code":"14010160","type":"CDM"},{"code":"510","type":"RC"},{"code":"10160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Heated Tubeset W/rtp","code_information":[{"code":"1600465","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600465","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Performance Series Sagittal Blade 18x0.89x90mm","code_information":[{"code":"1602133","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602133","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":177,"gross_charge":186,"discounted_cash":186,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":106}]}]},{"description":"Anaplasma Phagocytophilum Igm Pspc","code_information":[{"code":"35086666A","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Hp Anti Cardio Igm Pspc","code_information":[{"code":"35086147IGMHP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Hp Anti Cardio Igg Pspc","code_information":[{"code":"35086147IGGHP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Anaplasma Phagocytophilum Pspc","code_information":[{"code":"35086666P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Vaginal Pathogen Pcr Pspc","code_information":[{"code":"3500352UP","type":"CDM"},{"code":"306","type":"RC"},{"code":"0352U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Vit E, Tocopherol Pspc","code_information":[{"code":"35084446P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"46083 Incision Of Thrombosed Hemorrhoid, External","code_information":[{"code":"14046083","type":"CDM"},{"code":"510","type":"RC"},{"code":"46083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Absorbable Suture With Needle Stratafix","code_information":[{"code":"1602122","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":176,"gross_charge":185,"discounted_cash":185,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Beta-2 Glycoprotein 1 Antibodies, Ig G & Igm Pspc","code_information":[{"code":"35086146P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Thyroglobulin Pspc","code_information":[{"code":"35084432P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Urine Protein Electrophoresis Ran/24 Hr (Rps) Pspc","code_information":[{"code":"35084166RPS","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Cortisol Saliva Pspc","code_information":[{"code":"35082533SP","type":"CDM"},{"code":"301","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Folate Level","code_information":[{"code":"35082746","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"J2997 Cathflo (Alteplase) 2 Mg Sdv [Chas]","code_information":[{"code":"200J2997","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":175,"gross_charge":184,"discounted_cash":184,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":105}]}]},{"description":"Cyanide, Pspc","code_information":[{"code":"35082600P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":174,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":104}]}]},{"description":"Strp B Scr, Pen Alrgc Pspc","code_information":[{"code":"35087081P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":174,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":104}]}]},{"description":"17000 Destruction Benign/premalig Lesion Charge","code_information":[{"code":"20017000","type":"CDM"},{"code":"521","type":"RC"},{"code":"17000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":174,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":104}]}]},{"description":"Irrigation Bladder, Simple Charge","code_information":[{"code":"20051700","type":"CDM"},{"code":"521","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":174,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":104}]}]},{"description":"Destruction, Malign Lesion Trunk, Arms Or Legs; Lesion Diam 0.6 To 1.0 Cm  Charge","code_information":[{"code":"14017261","type":"CDM"},{"code":"510","type":"RC"},{"code":"17261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":172,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":103}]}]},{"description":"Minimum Inhibitory Concentration","code_information":[{"code":"35087186","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":171,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":103}]}]},{"description":"Paracentesis / Thoracentesis Kit Thora Para","code_information":[{"code":"1602121","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":171,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":103}]}]},{"description":"Reload Proximate Linear Stap","code_information":[{"code":"1601855","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601855","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":171,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":103}]}]},{"description":"Subsequent Nursing Facility Care (History, Examination And Mdm","code_information":[{"code":"20099307-CG","type":"CDM"},{"code":"524","type":"RC"},{"code":"99307","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":63,"maximum":171,"gross_charge":180,"discounted_cash":180,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":103}]}]},{"description":"20550-inj Tendon Sheath/ligament-surg Tech","code_information":[{"code":"12520550","type":"CDM"},{"code":"360","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":170,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":102}]}]},{"description":"29405 Application Of Short Leg Cast-clinic","code_information":[{"code":"20029405","type":"CDM"},{"code":"521","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":170,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":102}]}]},{"description":"Cefdinir 250 Mg/5 Ml Susp [Chas]","code_information":[{"code":"CP17640152376454058","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054898","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":170,"gross_charge":179,"discounted_cash":179,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":102}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Fluticasone-salmeterol 250 Mcg-50 Mcg Powder [Chas]","code_information":[{"code":"CP17640152376484871","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378932132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":169,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Saw Blade Narrow Sht","code_information":[{"code":"1600786","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600786","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":169,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Alpha-1 Antitryspin Pspc","code_information":[{"code":"35082103P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Pnh-cd59 Pspc","code_information":[{"code":"35086356P59","type":"CDM"},{"code":"305","type":"RC"},{"code":"86356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Dhea Serum Pspc","code_information":[{"code":"35082626P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Orthotic Mgmt And Training Charges","code_information":[{"code":"32097760-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"11601 Excision, Malignant Lesion Trunk .6 To 1.0 Cmsc Tech","code_information":[{"code":"14011601","type":"CDM"},{"code":"510","type":"RC"},{"code":"11601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"17110-destruct B9 Lesion 1-14-tech","code_information":[{"code":"14017110","type":"CDM"},{"code":"510","type":"RC"},{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Needle Inj Tak Adjust Tip","code_information":[{"code":"1600646","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600646","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"58300 Iud, Insert Charge","code_information":[{"code":"20058300","type":"CDM"},{"code":"521","type":"RC"},{"code":"58300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":168,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":101}]}]},{"description":"Blade Lg Wide 34.5 X 13.0","code_information":[{"code":"1600092","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600092","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":167,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"Carboplatin Inj  10mg/ml15 Ml [Chas]","code_information":[{"code":"CP17640152376456203","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703424601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":167,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlamydia Pneumoniae Ab, Igm Pspc Add-on 2","code_information":[{"code":"35086632P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"T Cells Total Pspc","code_information":[{"code":"35086359P","type":"CDM"},{"code":"305","type":"RC"},{"code":"86359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"Interleukin 6 (Rps) Pspc","code_information":[{"code":"35083529P","type":"CDM"},{"code":"302","type":"RC"},{"code":"83529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"Strep Pneumo 14 Serotype A/b, Pspc","code_information":[{"code":"35086317P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"Pt Sel Debrid Wo Anes > 20cm Asst Units","code_information":[{"code":"31097598-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97598","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"Patient office consultation, 40 min","code_information":[{"code":"20099243","type":"CDM"},{"code":"521","type":"RC"},{"code":"99243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":166,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":100}]}]},{"description":"17111-destruction Benign Lesion 15 Or More-sc Tech","code_information":[{"code":"14017111","type":"CDM"},{"code":"510","type":"RC"},{"code":"17111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":165,"gross_charge":174,"discounted_cash":174,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Flourescent Noninfect Agent Ab Pspc","code_information":[{"code":"35086256P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"11042dbrdmt Subq Tis 1st 20 Sqcm/<ed Tech","code_information":[{"code":"13511042","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Cortisol Pspc","code_information":[{"code":"35082533P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Haptoglobin Pspc","code_information":[{"code":"35083010P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Rocky Mt Spot Fever Igg Pspc","code_information":[{"code":"35086757GP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Rocky Mt Spot Fever Igm Pspc","code_information":[{"code":"35086757MP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Injection Sc/im","code_information":[{"code":"14596372","type":"CDM"},{"code":"263","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"17250 Chemical Cauterization Of Granulation Tissue (Ie Proud Flesh)-clinic","code_information":[{"code":"20017250","type":"CDM"},{"code":"521","type":"RC"},{"code":"17250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":164,"gross_charge":173,"discounted_cash":173,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":99}]}]},{"description":"Oxcarbazepine/eslicarbazepine Metabolite (Rps) Pspc","code_information":[{"code":"35080183P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}]},{"description":"Strep Confirmation","code_information":[{"code":"35087070","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}]},{"description":"11750-removal Of Nail Bed-sc Tech","code_information":[{"code":"14011750","type":"CDM"},{"code":"510","type":"RC"},{"code":"11750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}]},{"description":"Fibertape","code_information":[{"code":"1601937","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}]},{"description":"Leucovorin 100 Mg Rec [Chas]","code_information":[{"code":"CP17640152376492122","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Oxaliplatin 5 Mg/ml20 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376525474","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288010120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":163,"gross_charge":172,"discounted_cash":172,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":98}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Neomycin/polymyxin/hc Otic Drops10 Ml[chas]","code_information":[{"code":"CP17640152376520948","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":162,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"88275 Genetics; Interphase Insitu Unmc","code_information":[{"code":"35088275UNMC","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":162,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Electrolyte Panel1","code_information":[{"code":"35080051","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":162,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Eye Culture","code_information":[{"code":"35087070Y","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":162,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"98928  Omt 7-8 Body Regions-clinic","code_information":[{"code":"20098928","type":"CDM"},{"code":"521","type":"RC"},{"code":"98928","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":162,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"96372 Injection Sc/im Er Ed Tech","code_information":[{"code":"13596372","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Microalbumin Random Pspc","code_information":[{"code":"35082043F","type":"CDM"},{"code":"301","type":"RC"},{"code":"82043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Peroxidase (Tp0) Ab Pspc","code_information":[{"code":"35086376P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"97167 Ot Eval High Complex 60 Min (Untimed)","code_information":[{"code":"32097167-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Ot Gait Training, 15 Min","code_information":[{"code":"32097116-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97116","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"31097110-CQ","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"31097110-GP","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"51702 Insert Foley Cath  Charge","code_information":[{"code":"20051702","type":"CDM"},{"code":"521","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":162,"gross_charge":170,"discounted_cash":170,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":97}]}]},{"description":"Chlamydia Dna Add On Charge","code_information":[{"code":"35087491","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":161,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Acetylcysteine( 20%) 200 Mg/ml30 Ml Sdpf Inj [Chas]","code_information":[{"code":"CP17640152376436320","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594011102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":59,"maximum":161,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Testosterone Total Add On Charge 2","code_information":[{"code":"35084403P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Vasoactive Intestinal Polypeptide (Rps) Pspc","code_information":[{"code":"35084586P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84586","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"20551 Inj Tendon Single Clinic Charge","code_information":[{"code":"12520551","type":"CDM"},{"code":"360","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Airway Supraglottic Sz 4","code_information":[{"code":"1601558","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601558","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Airway Supraglottic Sz 5","code_information":[{"code":"1600081","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600081","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Walking Boot Lg","code_information":[{"code":"1601246","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601246","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Walking Boot Med","code_information":[{"code":"1601244","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601244","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"Walking Boot Sm","code_information":[{"code":"1601245","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601245","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":160,"gross_charge":168,"discounted_cash":168,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":96}]}]},{"description":"88342 Immunohistochemistry","code_information":[{"code":"35088342UNMC","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"C-reactive Protein","code_information":[{"code":"35086140","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Crypto Ag, Csf Pspc","code_information":[{"code":"35086403P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Chlamydia/gc Pcr Pspc","code_information":[{"code":"35087591P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Fracture Boot Xlg","code_information":[{"code":"1601509","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601509","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Fracture Boot Xsmall","code_information":[{"code":"1601511","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601511","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"14099203","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Inj, Anesthetic Agent; Other Peripheral Nerve Or Branch Charge","code_information":[{"code":"20064450","type":"CDM"},{"code":"521","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":159,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Ipe Assay Of Protein Urine Pspc","code_information":[{"code":"35084156P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Influenza A&b Pspc","code_information":[{"code":"35087804P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"35084153","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Rh Phenotyping Arc","code_information":[{"code":"35086906ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Spep Pspc","code_information":[{"code":"35084165P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}]},{"description":"Desmopressin 4 Mcg/ml Inj1 Ml [Chas]","code_information":[{"code":"CP17640152376461087","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":158,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":95}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Lactic Acid, Pspc","code_information":[{"code":"35083605P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":157,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":94}]}]},{"description":"Blade Oscil/sag Dual Cut","code_information":[{"code":"1601711","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601711","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":157,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":94}]}]},{"description":"Rosette Test Pspc","code_information":[{"code":"35086850P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":156,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Thc Metabolite, Serum, Quant Rps (Pspc)","code_information":[{"code":"35080349RPS","type":"CDM"},{"code":"301","type":"RC"},{"code":"80349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":156,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Cannula Gemini Sr8","code_information":[{"code":"1601911","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601911","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":156,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Fiberwire #2 Suture","code_information":[{"code":"1601739","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":156,"gross_charge":164,"discounted_cash":164,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Immunoglobulin A, Qn, Serum Pspc","code_information":[{"code":"35082784IAP","type":"CDM"},{"code":"302","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":155,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Ref Antibody Id","code_information":[{"code":"35086870","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":155,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Fsh Pspc","code_information":[{"code":"35083001P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":155,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"O/p, Fregn Trav Pspc","code_information":[{"code":"35087177P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":155,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Foley Catheter Bardexâ® Lubricathâ® 2-way Council Tip 5 Cc Balloon 16 Fr. Red Rubber","code_information":[{"code":"1602110","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":155,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":93}]}]},{"description":"Hepatitis B Core Antibody; Igm, Pspc","code_information":[{"code":"35086705P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"O & P Stain Add On","code_information":[{"code":"35087209","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Absc Gel 1","code_information":[{"code":"35086850","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Anti-thyroglob Pspc","code_information":[{"code":"35086800P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"35085025C","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"35085025","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Lysozyme Serum Pspc","code_information":[{"code":"35085549P","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Mumps Igg Pspc","code_information":[{"code":"35086735P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"96377application Of On-body Injection- Hosp","code_information":[{"code":"14596377","type":"CDM"},{"code":"263","type":"RC"},{"code":"96377","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Csf Culture","code_information":[{"code":"35087070C","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Ear Culture","code_information":[{"code":"35087070R","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"G0104ca Screen; Flexi Sigmoidscopesurg Tech","code_information":[{"code":"125G0104","type":"CDM"},{"code":"360","type":"RC"},{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"11107 Incisional Bx Of Skin; Each Sep/addl (In Addition To Primary Proc (Eg, Wedge)-clinic","code_information":[{"code":"20011107","type":"CDM"},{"code":"521","type":"RC"},{"code":"20011","type":"CPT","modifier":"107"}],"standard_charges":[{"setting":"outpatient","modifier_code":["107"],"minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"29515 Applic Of Short Leg Splint (Calf To Foot) Charge","code_information":[{"code":"20029515","type":"CDM"},{"code":"521","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":154,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Protein C Activity (Functional) (Rps) Pspc","code_information":[{"code":"35085303P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":153,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Screw Cortex Screw Self-tapping 3.5mm","code_information":[{"code":"1601919","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601919","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":153,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"90746 Hepatitis B Adult Vaccine [Chas]","code_information":[{"code":"20090746","type":"CDM"},{"code":"521","type":"RC"},{"code":"90746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":153,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":92}]}]},{"description":"Catheter Dual Sensor","code_information":[{"code":"1600188","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600188","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":152,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":91}]}]},{"description":"Trumpet Valve Irrig Systm","code_information":[{"code":"1601171","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601171","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":152,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":91}]}]},{"description":"Hepatitis B Vaccine, Adult","code_information":[{"code":"CP17640152238642978","type":"CDM"},{"code":"CP17640152238642978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":152,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":91}]}]},{"description":"Nicotine Metabolite, Urine (Rps) Pspc","code_information":[{"code":"35080323PU","type":"CDM"},{"code":"301","type":"RC"},{"code":"80323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":151,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":91}]}]},{"description":"Ridid Ndle 14.6 21ga","code_information":[{"code":"1600770","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600770","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":151,"gross_charge":159,"discounted_cash":159,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":91}]}]},{"description":"94668 Manipul Chest Wall Subseq Charge","code_information":[{"code":"30094668","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":150,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":90}]}]},{"description":"99348-level 2 Home Visit","code_information":[{"code":"20099348","type":"CDM"},{"code":"521","type":"RC"},{"code":"99348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":150,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":90}]}]},{"description":"Ab Id/each Selected Reagent Cell, Arc","code_information":[{"code":"35086885ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Ana (W/o Pattern) Pspc","code_information":[{"code":"35086038P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Albumin Glycated Pspc","code_information":[{"code":"35082985P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Digoxin Level Pspc","code_information":[{"code":"35080162P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Bier Block Charge","code_information":[{"code":"130001","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP130001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Excision Benign Lesion Includeing Margins, Except Skin Tags, Scalp, Neck, Hands, Feet, Genitalia;0.5","code_information":[{"code":"14011420","type":"CDM"},{"code":"510","type":"RC"},{"code":"11420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":149,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"35084153P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Aluminum Pspc","code_information":[{"code":"35082108P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Antibody Screen, Each Media, Arc","code_information":[{"code":"35086850ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Mthfr Dna Analysis Pspc","code_information":[{"code":"35081291P","type":"CDM"},{"code":"305","type":"RC"},{"code":"81291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Suture Retriever","code_information":[{"code":"1601642","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601642","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Manual Therapy Charge Unitsot Bce","code_information":[{"code":"32097140-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"97140 Manual Therapy Charge Units","code_information":[{"code":"31097140-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Manual Therapy Charge Units","code_information":[{"code":"31097140-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Foley Catheter Bardexâ® Lubricathâ® 2-way Council Tip 5 Cc Balloon 20 Fr. Red Rubber","code_information":[{"code":"1602112","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Foley Catheter Bardexâ® Lubricathâ® 2-way Council Tip 5 Cc Balloon 18 Fr. Red Rubber","code_information":[{"code":"1602111","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Needle Interstim 20gx5","code_information":[{"code":"1601564","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Needle Interstim 20x3 1/2","code_information":[{"code":"1600647","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600647","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Test Stimulation Cables","code_information":[{"code":"1601139","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601139","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Tracheostomy Tube 10mm","code_information":[{"code":"1601342","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601342","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}]},{"description":"Lipid Injectable Emulsion 20% Bag [Chas]","code_information":[{"code":"CP17640152376507510","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338954006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":148,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":89}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"M-protein Pspc","code_information":[{"code":"3500077UQM","type":"CDM"},{"code":"302","type":"RC"},{"code":"0077U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":147,"gross_charge":155,"discounted_cash":155,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Fiberchain #2","code_information":[{"code":"1601670","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601670","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":147,"gross_charge":155,"discounted_cash":155,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Paraneoplastic Auto Ab, Ia Quant Pspc","code_information":[{"code":"35083520P2","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Sex Hormone Binding Globulin Pspc","code_information":[{"code":"35084270P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Bill Ref Lab Rbc Antigen Id","code_information":[{"code":"35086902","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Fatty Acids, Free (Arup Via Rps)","code_information":[{"code":"35082725ARUP","type":"CDM"},{"code":"301","type":"RC"},{"code":"82725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Test Result Pspc","code_information":[{"code":"35083020P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Suture Prolene 1-0 Tp-1 D8785","code_information":[{"code":"1601883","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"11901 Inject Skin Lesions ]7clinic","code_information":[{"code":"20011901","type":"CDM"},{"code":"521","type":"RC"},{"code":"11901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}]},{"description":"Oxaliplatin 5mg/ml10 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376523563","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluticasone Nasal Spray16 Gm [Chas]","code_information":[{"code":"CP17640152376481670","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":146,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":88}]}],"drug_information":{"unit":16,"type":"GR"}},{"description":"Procalcitonin","code_information":[{"code":"35084145","type":"CDM"},{"code":"301","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":145,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"11740 Drain Blood Under Nailed Tech","code_information":[{"code":"12511740","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":145,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"Rsv Poc","code_information":[{"code":"52187807","type":"CDM"},{"code":"521","type":"RC"},{"code":"87807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":145,"gross_charge":153,"discounted_cash":153,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"Culture Aerobic, Sputum Pspc","code_information":[{"code":"35087070SP","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":144,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"Endomysial Antibody, Igg (Rps) Pspc","code_information":[{"code":"35086256RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":144,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"97165 Ot Eval Low Complex 30 Min (Untimed)","code_information":[{"code":"32097165-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":144,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"Neuromuscular Reeducation Charges","code_information":[{"code":"31097112-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":53,"maximum":144,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}]},{"description":"Fluticasone Prop/salmeterol 100-50 Mcg Inh[chas]","code_information":[{"code":"CP17640152376487582","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054032656","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":144,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":87}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Histoplasma Ab, Pspc","code_information":[{"code":"35086698P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86698","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"Strep Pneumo Ag, Urn Pspc","code_information":[{"code":"35087899P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"Surgifoam Sponge 8cm X 12.5mmx10mm","code_information":[{"code":"1601893","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601893","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"16000 Initial Treatment Of Burns Clinic","code_information":[{"code":"20016000","type":"CDM"},{"code":"521","type":"RC"},{"code":"16000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"65222 Rmvl Fb Ext Eye Conj With A Slit Lamp","code_information":[{"code":"20065222","type":"CDM"},{"code":"521","type":"RC"},{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus) >4 Lesions","code_information":[{"code":"20011057","type":"CDM"},{"code":"521","type":"RC"},{"code":"11057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":86}]}]},{"description":"P O2 Arterial","code_information":[{"code":"35036600","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Interpulse Handpiece W/hf Tip/suct Tube","code_information":[{"code":"1601646","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601646","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Ot Therapeutic Activ 15 Min","code_information":[{"code":"32097530-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"97166 Ot Moderate Complex Units","code_information":[{"code":"32097166-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Ot Reeval Units","code_information":[{"code":"32097168-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Ot Swallow Eval Charge","code_information":[{"code":"32092526-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"92526","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"32097110-GO","type":"CDM"},{"code":"429","type":"RC"},{"code":"97110","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Ultrasound Charges","code_information":[{"code":"32097035-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Wheelchair Charge","code_information":[{"code":"32097542-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97542","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Pt Therapeutic Activity Assistant Units","code_information":[{"code":"31097530-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Pt Orthotic Management, Train Minutes","code_information":[{"code":"31097760-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Gait Training Charges","code_information":[{"code":"31097116-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Therapeutic Activities Charge","code_information":[{"code":"31097530-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Acne Surgery","code_information":[{"code":"14010040","type":"CDM"},{"code":"510","type":"RC"},{"code":"10040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Blade Precision Thin Medium Long","code_information":[{"code":"1601735","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Dressing V.a.c. Granufoam Medium","code_information":[{"code":"1601780","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601780","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Flexi-seal Collection Bag","code_information":[{"code":"1601825","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601825","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":143,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"96361 Iv Hydration Ea Addl Hred Tech","code_information":[{"code":"13596361","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":142,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"17-a-oh-progesterone","code_information":[{"code":"35083498","type":"CDM"},{"code":"301","type":"RC"},{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":142,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Flu, Rsv Combo Pspc","code_information":[{"code":"35087631P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":142,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Hep C Virus, Ab Pspc","code_information":[{"code":"35086803P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":142,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":85}]}]},{"description":"Myeloperoxidase (Mpo) Antibody (Rps)","code_information":[{"code":"35083516MPO","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":141,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Cannula Dri-lok Threaded","code_information":[{"code":"1601771","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601771","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":141,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Tourniquet Cuff 34 Disposable","code_information":[{"code":"1601838","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601838","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":141,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Measles, Mumps, Rubella & Varicella Vaccine","code_information":[{"code":"20090715","type":"CDM"},{"code":"521","type":"RC"},{"code":"90715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":141,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"20553 Inj(s); Single Or Mult Trigger Point(s), Three Or More Muscle(s) Charge","code_information":[{"code":"20020553","type":"CDM"},{"code":"521","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":141,"gross_charge":148,"discounted_cash":148,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Phenytoin, Free Charge","code_information":[{"code":"35080186","type":"CDM"},{"code":"301","type":"RC"},{"code":"80186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"G0008-admin Influenza Virus Vac-tech","code_information":[{"code":"105G0008","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"G0009-admin Pneumococcal Vaccine-tech","code_information":[{"code":"105G0009","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Histoplasma Galacto Ag, Quant By Eia, Urine Pspc","code_information":[{"code":"35087385UP","type":"CDM"},{"code":"302","type":"RC"},{"code":"87385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Mrsa Scr, Pcr Pspc","code_information":[{"code":"35087641P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87641","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Parvo B19, Igg/igm Pspc","code_information":[{"code":"35086747P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Wound Culture","code_information":[{"code":"35087070W","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Pt Manual Therapy Assistant Units","code_information":[{"code":"31097140-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Sponge Counter Bag","code_information":[{"code":"1601380","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601380","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":140,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":84}]}]},{"description":"Aso Quant Pspc","code_information":[{"code":"35086060P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":139,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"Lh Lut Hormone Pspc","code_information":[{"code":"35083002P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":139,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"Urine Culture(rps) Pspc","code_information":[{"code":"35087086P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":139,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"Urine Culture","code_information":[{"code":"35087086","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":139,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"40800-drainage Of Mouth Lesion-sc Tech","code_information":[{"code":"14040800","type":"CDM"},{"code":"510","type":"RC"},{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":139,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"Edena Wear Stocking","code_information":[{"code":"1601836","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":138,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}]},{"description":"Iron Sucrose 20 Mg/ml5 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376492873","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":138,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vasopressin 20 Units/ml Inj Sol[chas]","code_information":[{"code":"CP17640152376566749","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":138,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":83}]}],"drug_information":{"unit":20,"type":"UN"}},{"description":"Mat Absorbent 50inx34in","code_information":[{"code":"1602074","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602074","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":137,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Anti-sjogren, Ss-a Abs Add On Charge","code_information":[{"code":"35086235SSA","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":137,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Anti-sjogren, Ss-b Abs Add On Charge","code_information":[{"code":"35086235SSB","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":137,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Procalcitonin, Pspc","code_information":[{"code":"35084145P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":137,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Good T-tube Modified, Ventilaton Tube","code_information":[{"code":"1601721","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601721","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":137,"gross_charge":144,"discounted_cash":144,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Ephedrine 50 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376471638","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781326995","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":136,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Amylase Level","code_information":[{"code":"35082150","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":136,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Calcitonin, Pspc","code_information":[{"code":"35082308P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":136,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"O & P Screen Pspc","code_information":[{"code":"35087329P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":136,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Surg Path L Iv, Tc Bioref","code_information":[{"code":"350G0416","type":"CDM"},{"code":"311","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":136,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":82}]}]},{"description":"Albumin Humin 25% Sol [Chas]","code_information":[{"code":"CP17640152376437330","type":"CDM"},{"code":"250","type":"RC"},{"code":"68982064301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Auto Bacterial Id Urine","code_information":[{"code":"35087088","type":"CDM"},{"code":"306","type":"RC"},{"code":"87088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Hbeag, Pspc","code_information":[{"code":"35087350P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"31720-clearance Of  Airways-edtech","code_information":[{"code":"13531720","type":"CDM"},{"code":"450","type":"RC"},{"code":"31720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Coccidioides Igg Pspc","code_information":[{"code":"35086635GP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Coccidioides Igm Pspc","code_information":[{"code":"35086635P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Sars-cov-2 (Covid-19) Rna (Id Now)","code_information":[{"code":"35087635","type":"CDM"},{"code":"302","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Sars-cov-2 (Covid-19) Total Antibodies","code_information":[{"code":"35086769","type":"CDM"},{"code":"302","type":"RC"},{"code":"86769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Sars-cov-2, Flu, & Rsv Combo (Rps) Pspc","code_information":[{"code":"35087631RP","type":"CDM"},{"code":"302","type":"RC"},{"code":"87631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Tissue Transglutaminase Igg Ab Pspc","code_information":[{"code":"35083516PTTG","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Pt Neuromuscular Reeducation Assistant Units","code_information":[{"code":"31097112-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"99212 Office/op Established  Visit Level 2","code_information":[{"code":"20099212-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"99212","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"98927  Omt 5-6 Body Regions-clinic","code_information":[{"code":"20098927","type":"CDM"},{"code":"521","type":"RC"},{"code":"98927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":135,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":81}]}]},{"description":"Lithium Pspc","code_information":[{"code":"35080178P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":134,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Tray Combo Spinal/epid","code_information":[{"code":"1601578","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":134,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"90696 Diphtheria-tetanus-acc Pertussis-polio(dtap) [Chas]","code_information":[{"code":"20090696","type":"CDM"},{"code":"521","type":"RC"},{"code":"90696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":134,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Albumin Human 5%250 Ml Sol[chas]","code_information":[{"code":"CP17640152376436406","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":134,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Thromboplastin Time, Partial, Plasma Frac Pspc","code_information":[{"code":"35085732P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Gastrin Pspc","code_information":[{"code":"35082941P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Herpes Simplex I/ii Igg, Pspc","code_information":[{"code":"35086694P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Ot Strapping, Shoulder Units","code_information":[{"code":"32029240-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"29240","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Pt Reeval Units","code_information":[{"code":"31097164-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Extendevac Electrosurgical Pencil","code_information":[{"code":"1601707","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601707","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":133,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":80}]}]},{"description":"Strep A Screen 1","code_information":[{"code":"35087880","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Blade Reciprocating","code_information":[{"code":"1601654","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601654","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Pt Gait Training Assistant Units","code_information":[{"code":"31097116-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Pt Orthotic Management, Train Assistant Units","code_information":[{"code":"31097760-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Pt Canalith Repositioning Charge","code_information":[{"code":"31095992-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Ostomy Odor Eliminator 8 Oz","code_information":[{"code":"1601882","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601882","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":132,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Aldolase Pspc","code_information":[{"code":"35082085P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Coenzyme Q10, Total (Rps) Pspc","code_information":[{"code":"35082542COQ","type":"CDM"},{"code":"301","type":"RC"},{"code":"82542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"12032 Intmd Rpr S/a/t/ext 2.6-7.5 -Sc Tech","code_information":[{"code":"14012032","type":"CDM"},{"code":"510","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Tourniquet Cuff 30 Disposable","code_information":[{"code":"1601837","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601837","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Office/op New Visit Level 1 99201","code_information":[{"code":"20099201","type":"CDM"},{"code":"521","type":"RC"},{"code":"99201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine And Poliovirus Vaccine, Inactivated (Dtap-i","code_information":[{"code":"20090696-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90696","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":48,"maximum":131,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":79}]}]},{"description":"99409 Alcohol Counselinger Tech","code_information":[{"code":"13599409","type":"CDM"},{"code":"450","type":"RC"},{"code":"99409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":130,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Pancreatic Elastase, Fecal Pspc","code_information":[{"code":"35083520PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":130,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Rapid Hiv 1","code_information":[{"code":"35086703","type":"CDM"},{"code":"302","type":"RC"},{"code":"86703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":130,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Attended E-stim Charges","code_information":[{"code":"32097032-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":48,"maximum":130,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Dnu Cognitive Skills Development Charges","code_information":[{"code":"32097127-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97127","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":48,"maximum":130,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"35085730","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Drill Bit","code_information":[{"code":"1601643","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601643","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"11402-exc-tr-ext B9+marg 1.1-2 Cm-sc Tech","code_information":[{"code":"14011402","type":"CDM"},{"code":"510","type":"RC"},{"code":"11402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Bd Dexa Vfa Only","code_information":[{"code":"36077086","type":"CDM"},{"code":"320","type":"RC"},{"code":"77086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Pessary Ring W/o Support","code_information":[{"code":"1601774","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601774","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Suture Retreiver Small","code_information":[{"code":"1601811","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601811","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Suture Retriever Lare","code_information":[{"code":"1601809","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Suture Retriever Medium","code_information":[{"code":"1601810","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Tamponade W/airway  5.5","code_information":[{"code":"1601550","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601550","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Tamponade W/airway 7.5","code_information":[{"code":"1601553","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601553","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}]},{"description":"Leucovorin 50 Mg Rec [Chas]","code_information":[{"code":"CP17640152376492230","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143955501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":129,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":78}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"G Vaginalis Pcr Add On","code_information":[{"code":"35087510","type":"CDM"},{"code":"300","type":"RC"},{"code":"87510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":128,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":77}]}]},{"description":"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less","code_information":[{"code":"14017260","type":"CDM"},{"code":"510","type":"RC"},{"code":"17260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":128,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":77}]}]},{"description":"Chest Drain Valve Heimlic","code_information":[{"code":"1601301","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":128,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":77}]}]},{"description":"11105 Punch Bx Ea Sep/addl Lesion (In Addition To Primary Proc)-clinic","code_information":[{"code":"20011105","type":"CDM"},{"code":"521","type":"RC"},{"code":"11105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":128,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":77}]}]},{"description":"Citric Acid  Pspc","code_information":[{"code":"35082507P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":127,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Sars Cov-2 Igg Ab (Rps) Pspc","code_information":[{"code":"35086769P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":127,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"92960-cardioversion Electric Ext-sc Tech","code_information":[{"code":"14092960","type":"CDM"},{"code":"510","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":127,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Antithrombin Iii, Activity (Functional) (Rps) Pspc","code_information":[{"code":"35085300P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Lamotrigine, Lamictal Pspc","code_information":[{"code":"35080175P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Tracheostomy Tube 4.0mm","code_information":[{"code":"1601339","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601339","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"G0108 Diabetes Self-management Training, Per 30 Minutes","code_information":[{"code":"200G0108","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Aspirate/inj Ganglion Cyst-clinic Charge","code_information":[{"code":"20020612","type":"CDM"},{"code":"521","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}]},{"description":"Vancomycin 1.5 G/300 Ml Ivpb [Chas]","code_information":[{"code":"CP17640152376564052","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Zoledronic Acid 4 Mg/5 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376565155","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598023311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":126,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":76}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Microalbumin Urine Pspc Add On Charge","code_information":[{"code":"35082043P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Bleeding Time","code_information":[{"code":"35085002","type":"CDM"},{"code":"300","type":"RC"},{"code":"85002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Free T4","code_information":[{"code":"35084439","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Mono Screen 3","code_information":[{"code":"35086308","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Paternity Collection","code_information":[{"code":"350005","type":"CDM"},{"code":"300","type":"RC"},{"code":"CP350005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Strep A 2, Nucleic Acid","code_information":[{"code":"35087651QW","type":"CDM"},{"code":"302","type":"RC"},{"code":"87651","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Dsdna (Double Stranded Dna) Pspc","code_information":[{"code":"35086225P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Iontophoresis Charges","code_information":[{"code":"31097033-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"29065-application Of Long Arm Cast-sc Tech","code_information":[{"code":"14029065","type":"CDM"},{"code":"510","type":"RC"},{"code":"29065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Iv Hydration  Additional Hour Tech Chg","code_information":[{"code":"14596361","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Xr Sternoclavicular Joint(s)","code_information":[{"code":"36071130","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Ankle Walker Md","code_information":[{"code":"1600045","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1600045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Tracheostomy Tube 6mm","code_information":[{"code":"1601343","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601343","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Tracheostomy Tube 8mm","code_information":[{"code":"1601341","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601341","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus); 2 To 4  Lesions","code_information":[{"code":"20011056","type":"CDM"},{"code":"521","type":"RC"},{"code":"11056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":125,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"95251-cont Gluc Mntr Analysis I&r-tech","code_information":[{"code":"17095251","type":"CDM"},{"code":"942","type":"RC"},{"code":"95251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":124,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":75}]}]},{"description":"Cannula 150mm20ga Cvd","code_information":[{"code":"1600142","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":124,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"36000 Place Needle In Veined Tech","code_information":[{"code":"13536000","type":"CDM"},{"code":"450","type":"RC"},{"code":"36000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"Antiproteinase 3 (Pr3) Antibody (Rps) Pspc","code_information":[{"code":"35083516PR","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"Catecholamines/crt Ratio Pspc","code_information":[{"code":"35082570P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"Manual Microdissection Unmc Pspc","code_information":[{"code":"35088381","type":"CDM"},{"code":"310","type":"RC"},{"code":"88381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"Pt Canalith Repositioning Assistant Units","code_information":[{"code":"31095992-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"29075 Cast Arm Short Apply -Sc Tech","code_information":[{"code":"14029075","type":"CDM"},{"code":"510","type":"RC"},{"code":"29075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"65220 Desc For Removal Foreign Body Corneal, W/o Slit Lamp-clinic","code_information":[{"code":"20065220","type":"CDM"},{"code":"521","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}]},{"description":"Diphtheria/pertussis/tetanus 0.5 Ml Syringe[chas]","code_information":[{"code":"CP17640152376473565","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":123,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":74}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"83521 Free Kap/lamb Lite Chain Pspc","code_information":[{"code":"35083521P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Campy Ag Add On Charge","code_information":[{"code":"35087899C","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Herpes Simplex Type 2, Pspc","code_information":[{"code":"35086696P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Shiga Tox Add On 1","code_information":[{"code":"35087899","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Bile Acids, Total Pspc","code_information":[{"code":"35082239P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Hemoglobin A1c","code_information":[{"code":"35083036","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Methylmal Acid, Ser Pspc","code_information":[{"code":"35083921P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Pt Strapping Elbow, Wrist Charge","code_information":[{"code":"31029260-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"29260","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Pt Strapping Hand, Finger Units","code_information":[{"code":"31029280-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"29280","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Tamponade 5.5cm","code_information":[{"code":"1601552","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601552","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"20550 Injection(s); Single Tendon Sheath, Or Ligament, Apo Neurosis (Eg, Plantar Fascia)","code_information":[{"code":"20020550","type":"CDM"},{"code":"521","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"20552 Inj(s); Single Or Mult Trigger Point(s), One Or Two Muscle(s) Charge","code_information":[{"code":"20020552","type":"CDM"},{"code":"521","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}]},{"description":"Phytonadione 10 Mg/ml Inj Sol[chas]","code_information":[{"code":"CP17640152376530938","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":122,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":73}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carboplatin Inj 10mg/ml5 Ml [Chas]","code_information":[{"code":"CP17640152376459918","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703424401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cytology Cell Block, Tc Pspc","code_information":[{"code":"35088305P","type":"CDM"},{"code":"311","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Fecal Leukocytes","code_information":[{"code":"35089055","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Legal Blood Draw","code_information":[{"code":"350001","type":"CDM"},{"code":"300","type":"RC"},{"code":"CP350001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Dressing Mepilex Ag 4 X 12","code_information":[{"code":"1601661","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601661","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Ot Cognitive Function Medicare Charge","code_information":[{"code":"320G0515-G0","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0515","type":"HCPCS","modifier":"G0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["G0"],"minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Pt Cable For Interstim","code_information":[{"code":"1600750","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600750","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Foreign Body Remove, Superficial Conjunctival Charge","code_information":[{"code":"20065205","type":"CDM"},{"code":"521","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":121,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"29260-strapping Of Elbow Or Wrist-ed Tech","code_information":[{"code":"13529260","type":"CDM"},{"code":"450","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"17-hydroxyprogest Pspc","code_information":[{"code":"35083498P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Androstenedione (Rps) Pspc","code_information":[{"code":"35082157P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"90471 Immunization Admin- Op Tech","code_information":[{"code":"14590471","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Sensor Bilateral","code_information":[{"code":"1601671","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601671","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Ot Therapeutic Procedure","code_information":[{"code":"32097150-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97150","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"41100biopsy Of Toungesc Tech","code_information":[{"code":"14041100","type":"CDM"},{"code":"510","type":"RC"},{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Karl Storz Endoscopy Endoscopic Seal","code_information":[{"code":"1602117","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602117","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Thrml Opt Ii Biop Forcep","code_information":[{"code":"1601147","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Unna Boot (Uni)","code_information":[{"code":"20029580","type":"CDM"},{"code":"521","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":120,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":72}]}]},{"description":"Canister Freedom W/gel V.a.c.","code_information":[{"code":"1601781","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601781","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":119,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Hip/knee Kit Delux","code_information":[{"code":"1600485","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":119,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Fluorouracil 50 Mg/ml 20 Ml [Chas]","code_information":[{"code":"CP17640152376483451","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":119,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Anti-smith Abs Add On Charge","code_information":[{"code":"35086235SM","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Herpes Simplex Type 1, Pspc","code_information":[{"code":"35086695P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"96368-ther/diag Concurrent Inf- Er Tech","code_information":[{"code":"13596368","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Pt Iontophoresis Assistant Units","code_information":[{"code":"31097033-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"31575 Dx Laryngoscopy","code_information":[{"code":"14031575","type":"CDM"},{"code":"510","type":"RC"},{"code":"31575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Iv Meds 2nd Med Concurrent","code_information":[{"code":"14596368","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Gastrostomy Tube 16fr","code_information":[{"code":"1601540","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601540","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Insole Lynco Orthodic","code_information":[{"code":"1601561","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601561","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"90681 Rotavirus Human Attenuated. 2 Dose Live [Chas]","code_information":[{"code":"20090681","type":"CDM"},{"code":"521","type":"RC"},{"code":"90681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":118,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":71}]}]},{"description":"Giardia Antigen By Eia,  (Arup) Pspc","code_information":[{"code":"35087329","type":"CDM"},{"code":"302","type":"RC"},{"code":"87329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":117,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Levet (Keppra) Pspc","code_information":[{"code":"35080177P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":117,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"99347 Home Visit Level 1 Established99347","code_information":[{"code":"20099347","type":"CDM"},{"code":"521","type":"RC"},{"code":"99347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":117,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Arthro, Ankle; Tibiotalar And Fibulotalar Joints","code_information":[{"code":"20011900","type":"CDM"},{"code":"521","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":117,"gross_charge":123,"discounted_cash":123,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"35085025HP","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Free T4 Ed Pspc","code_information":[{"code":"35084439P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Lead, Adult Pspc","code_information":[{"code":"35083655P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Methemoglobin Pspc","code_information":[{"code":"35083050P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Plasminogen Activity Pspc","code_information":[{"code":"35085420P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Blade Long Narrow 29.5mml X 7mm","code_information":[{"code":"1602006","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Gastrostomy Tube 18fr","code_information":[{"code":"1601541","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601541","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Picc Line Insertioncrna","code_information":[{"code":"20011000","type":"CDM"},{"code":"521","type":"RC"},{"code":"11000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":116,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":70}]}]},{"description":"Hepatitis Be Antibody, Pspc","code_information":[{"code":"35086707P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Direct Coombs","code_information":[{"code":"35086880","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"93668 Peripheral Vascular Rehab","code_information":[{"code":"34093668","type":"CDM"},{"code":"943","type":"RC"},{"code":"93668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Anora Client Bill","code_information":[{"code":"350ANORA","type":"CDM"},{"code":"300","type":"RC"},{"code":"99999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"C Diff Pcr (Rps) Pspc","code_information":[{"code":"35087493RP","type":"CDM"},{"code":"302","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Ldl Chol, Direct Pspc","code_information":[{"code":"35083721P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Magnesium Level","code_information":[{"code":"35083735","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Malaria Prep Pspc","code_information":[{"code":"35087207P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Hcg Qualitative, Urineclinic","code_information":[{"code":"35081025C","type":"CDM"},{"code":"307","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Hcg Qualitative, Urine 2","code_information":[{"code":"35081025","type":"CDM"},{"code":"307","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Electronic Analysis Of Implanted Neurostimulator Pulse Gener","code_information":[{"code":"14017000","type":"CDM"},{"code":"510","type":"RC"},{"code":"17000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Sensory Integration Charges","code_information":[{"code":"33097533-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"97533","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Catheter 6fr Filiform Straight","code_information":[{"code":"1601570","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601570","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}]},{"description":"Gemcitabine 100 Mg/ml 20 Ml Mdv1 Ml [Chas]","code_information":[{"code":"CP17640152376482005","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729042605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ketorolac Ophthalmic 0.4% Sol5 Ml [Chas]","code_information":[{"code":"CP17640152376491799","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758077305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":115,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":69}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Cytopath, Eval Of Fine Needle Asp Pspc","code_information":[{"code":"35088173P","type":"CDM"},{"code":"310","type":"RC"},{"code":"88173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":114,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"T4 Total T4 Pspc","code_information":[{"code":"35084436P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":114,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Cannula Self-retaining","code_information":[{"code":"1601673","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601673","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":114,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Cannulas Gemini","code_information":[{"code":"1601938","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":114,"gross_charge":120,"discounted_cash":120,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Csf Igg Add On Charge","code_information":[{"code":"35082784G","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Creatinine","code_information":[{"code":"35082570","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Iga, Qn, Serum Charge Add On","code_information":[{"code":"35082784A","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Igm, Qn, Serum Charge Add On","code_information":[{"code":"35082784M","type":"CDM"},{"code":"301","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Serum Igg Add On Charge","code_information":[{"code":"35082784S","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Catheterize For Urine Spec","code_information":[{"code":"350P9612","type":"CDM"},{"code":"307","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Dhea Sulfate Pspc","code_information":[{"code":"35082627P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Immunoglobulin A (Iga) (Rps) Pspc","code_information":[{"code":"35082784PA","type":"CDM"},{"code":"302","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Phos Value, Ur 24-hr Pspc","code_information":[{"code":"35084105P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Pt Wheelchair Management Assistant Units","code_information":[{"code":"31097542-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Wheelchair Management Charges","code_information":[{"code":"31097542-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Coumadin Clinic","code_information":[{"code":"140025","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"Tourniquet Cuff Single 30 Disp W/ Sleeve","code_information":[{"code":"1602059","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"11103 Tangential Bx Of Skin Ea Sep/addl (Eg, Shave, Scoop, Saucerize, Curette)-clinic","code_information":[{"code":"20011103","type":"CDM"},{"code":"521","type":"RC"},{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":113,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":68}]}]},{"description":"11719-trim Nail(s) Any Number-ed Tech","code_information":[{"code":"13511719","type":"CDM"},{"code":"450","type":"RC"},{"code":"11719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Tap Block Unilateral","code_information":[{"code":"13564486","type":"CDM"},{"code":"450","type":"RC"},{"code":"64486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Crohn Disease Prognostic Panel(rps) Pspc","code_information":[{"code":"35083516CDPP","type":"CDM"},{"code":"302","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"11404exc Tr-ext B9+marg 3.1-4 Cm -Sc Tech","code_information":[{"code":"14011404","type":"CDM"},{"code":"510","type":"RC"},{"code":"11404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"29405 Short Leg Cast/below Knee To Toes Clinic Charge","code_information":[{"code":"14029405","type":"CDM"},{"code":"510","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"69424-ventilating Tube Removal W/anes-sc Tech","code_information":[{"code":"14069424","type":"CDM"},{"code":"510","type":"RC"},{"code":"69424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Change Of Cystostomy Tube; Complicated","code_information":[{"code":"14051710","type":"CDM"},{"code":"510","type":"RC"},{"code":"51710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Catheter Abdominal 7 Fr","code_information":[{"code":"1600183","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600183","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":112,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Crypto Ag Screen Add On","code_information":[{"code":"35087328","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Thyroid Hormone Uptake Pspc","code_information":[{"code":"35084479P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"35085610","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"In Situ Hybridization, Each Unmc Pspc","code_information":[{"code":"35088365UNMC","type":"CDM"},{"code":"300","type":"RC"},{"code":"88365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Diab Manage Trn Per Indiv, Per 30 Min","code_information":[{"code":"170G0108","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}]},{"description":"Ceftriaxone 1 Gm Vial[chas]","code_information":[{"code":"CP17640152376454283","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":111,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":67}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ehrlichia Hge, Igm Pspc","code_information":[{"code":"35086666EA","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Ck, Total Pspc","code_information":[{"code":"35082550P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Ehrlichia Hge, Igg/igm Pspc","code_information":[{"code":"35086666EP","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Fecal Fat Qual Pspc","code_information":[{"code":"35082705P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Oxycodone Screen, Urine Pspc","code_information":[{"code":"350OXY","type":"CDM"},{"code":"301","type":"RC"},{"code":"80301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Blade Aggr. Med","code_information":[{"code":"1601547","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601547","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Tourniquet Cuff Single 24 W/sleeve","code_information":[{"code":"1602103","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602103","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Tetracaine 1%  Inj Sol 10 Mg/ml2 Ml [Chas]","code_information":[{"code":"CP17640152376555192","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":110,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Electrode Spatula 5mm","code_information":[{"code":"1600354","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600354","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":109,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Rapid Flu Poc","code_information":[{"code":"20087804","type":"CDM"},{"code":"521","type":"RC"},{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":109,"gross_charge":115,"discounted_cash":115,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":66}]}]},{"description":"Bill Only Helicobacter Pspc","code_information":[{"code":"35088212HBPN","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"C Diff Toxin And Antigen (87449) Confirmatory Testing (Rsp) Pspc","code_information":[{"code":"35087493P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Coombs Test, Arc","code_information":[{"code":"35086880ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Dot Drug Collection Fee","code_information":[{"code":"350002","type":"CDM"},{"code":"300","type":"RC"},{"code":"CP350002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Fungus Culture, (Rps)","code_information":[{"code":"35087102RPS","type":"CDM"},{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"S-2 Pas, Pspc","code_information":[{"code":"35088312P","type":"CDM"},{"code":"300","type":"RC"},{"code":"88312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Sle Profile (A) Pspc","code_information":[{"code":"35086431P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"29345-application Of Long Leg Cast-sc Tech","code_information":[{"code":"14029345","type":"CDM"},{"code":"510","type":"RC"},{"code":"29345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"57500 Biopsy Of Cervix","code_information":[{"code":"14057500","type":"CDM"},{"code":"510","type":"RC"},{"code":"57500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"58100 Endometrial Biopsy","code_information":[{"code":"14058100","type":"CDM"},{"code":"510","type":"RC"},{"code":"58100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Mesh Prolite 2x 4 Herinia","code_information":[{"code":"1601378","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601378","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}]},{"description":"Protamine 10 Mg/ml25 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376540655","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":108,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":65}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gtt 1-hour","code_information":[{"code":"35082950","type":"CDM"},{"code":"301","type":"RC"},{"code":"82950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Hpv High Risk, W/rflx To Genotype Pspc","code_information":[{"code":"35087624P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"50690-injection For Ureter Xray-sc Tech","code_information":[{"code":"12550690","type":"CDM"},{"code":"360","type":"RC"},{"code":"50690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Tracheostomy Tube 7mm","code_information":[{"code":"1601340","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601340","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"90714 Tetanus And Diptheria Toxoids Adsorbed, Preservative Free, For Use In In Indv 7yrs Poc Charge","code_information":[{"code":"20090714","type":"CDM"},{"code":"521","type":"RC"},{"code":"90714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Fluorouracil 50 Mg/ml10 Mlsol [Chas]","code_information":[{"code":"CP17640152376482219","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":107,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Celiac Disease Add On 2","code_information":[{"code":"35082784","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":106,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Hemoglobin, Free, Plasma Pspc","code_information":[{"code":"35083051P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":106,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"99211 Estab Pat Level 1","code_information":[{"code":"14599211","type":"CDM"},{"code":"761","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":106,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Edema Wear Stocking Lg","code_information":[{"code":"1601896","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601896","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":106,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Thumsling Long Left","code_information":[{"code":"1601599","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601599","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":106,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":64}]}]},{"description":"Hsv 1, Igm Type Spec Pspc","code_information":[{"code":"35086695MP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Hsv 2, Igm Type Spec Pspc","code_information":[{"code":"35086696MP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Bill Ref Lab Preselect Unit","code_information":[{"code":"35086904","type":"CDM"},{"code":"300","type":"RC"},{"code":"86904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Acid Fast Bacteria, Pspc","code_information":[{"code":"35087116P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Pepper Chili, Ige Pspc","code_information":[{"code":"35086003PP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Medi-flow Lens","code_information":[{"code":"1600604","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600604","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"11740 Drain Blood Under Nailclinic","code_information":[{"code":"20011740","type":"CDM"},{"code":"521","type":"RC"},{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Bordetella Pertussis Ab, Igg Imblot Pspc","code_information":[{"code":"35086615IGP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Estrogens, T Ser Pspc","code_information":[{"code":"35082671P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Wet Prep 5","code_information":[{"code":"35087210","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"Endoscopic Marker","code_information":[{"code":"1600372","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600372","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":105,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":63}]}]},{"description":"86360- T4/t8 Ratio; T Cells, Abs Pspc","code_information":[{"code":"35086360P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Estriol Add On Charge","code_information":[{"code":"35082677P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"5' Nucleotidase (Rps) Pspc","code_information":[{"code":"35083915P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Fibrinogen Activ Pspc","code_information":[{"code":"35085384P","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Us Guided Biopsy Prostate","code_information":[{"code":"36076942","type":"CDM"},{"code":"360","type":"RC"},{"code":"76942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Trocar 12mm X 100mm Handled","code_information":[{"code":"1601994","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Turfliner Full Steel","code_information":[{"code":"1601180","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601180","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Amiodarone/dextrose 150mg Bag [Chas]","code_information":[{"code":"CP17640152376446015","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Insulin Regular / Ns 100 Unit/100ml [Chas]","code_information":[{"code":"CP17640152376497042","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":104,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Ref Antigen Type","code_information":[{"code":"35086905","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Carnitine, Free & Total Rps","code_information":[{"code":"35082379RPS","type":"CDM"},{"code":"301","type":"RC"},{"code":"82379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Ethosuximide, Pspc","code_information":[{"code":"35080168P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Parietal Cell Antibodies (Rps) Pspc","code_information":[{"code":"35083516APCA","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Thyroid Hormone Receptor Antibody (Rps) Pspc","code_information":[{"code":"35083520TRP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"11055 Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus); Single Lesion Charge","code_information":[{"code":"20011055","type":"CDM"},{"code":"521","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"98926 Omt 3-4 Body Regions-clinic","code_information":[{"code":"20098926","type":"CDM"},{"code":"521","type":"RC"},{"code":"98926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}]},{"description":"Olanzapine 10 Mg Rec Vial [Chas]","code_information":[{"code":"CP17640152376520312","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315972","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":103,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":62}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"83521","code_information":[{"code":"35083521MYO","type":"CDM"},{"code":"301","type":"RC"},{"code":"83521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Urine Protein-np Add On","code_information":[{"code":"35084156","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"25-hydroxyvitamin D2 And D3 Pspc","code_information":[{"code":"35082306P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Immunofixation, Urine Pspc","code_information":[{"code":"35086335IMFU","type":"CDM"},{"code":"301","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Islet Cell Ab Pspc","code_information":[{"code":"35086341P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Osteocalcin Pspc","code_information":[{"code":"35083937P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Tuohy-borst Adapter","code_information":[{"code":"1601492","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601492","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"90713 Ipv Inactivated Poliovirus Vaccine [Chas]","code_information":[{"code":"20090713","type":"CDM"},{"code":"521","type":"RC"},{"code":"90713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"20600 Arthrocentesis, Aspirtn And/or Inj; Small Joint Or Bursa (Eg, Fingers, Toes) Charge","code_information":[{"code":"20020600","type":"CDM"},{"code":"521","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Bx Done W/colposocopy Add-onclinic","code_information":[{"code":"20058110","type":"CDM"},{"code":"521","type":"RC"},{"code":"58110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":102,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":61}]}]},{"description":"Ft3 Free T3 Pspc","code_information":[{"code":"35084481P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":101,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Bur Round 4.0","code_information":[{"code":"1600125","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600125","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":101,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Q-fever Ab Pspc","code_information":[{"code":"35086638P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86638","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":100,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Crossflow Outflow Cassette Tubing","code_information":[{"code":"1602051","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":100,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Vacuum Deliver Assist","code_information":[{"code":"1601218","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601218","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":100,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Varifit Cuff Adult Single","code_information":[{"code":"1601220","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601220","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":100,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"96402 Chemo Hormon Sq/im Charge Profee","code_information":[{"code":"14096402","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":100,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":60}]}]},{"description":"Auto Bacterial Id Other Src","code_information":[{"code":"35087077","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":99,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Bacterial Id Pspc","code_information":[{"code":"35087077P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":99,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Tourniquet Cuff Single 18 Disp W/ Sleeve","code_information":[{"code":"1601963","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601963","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":99,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Tetanus-diphtheria Toxoids Adult Im Susp 0.5 Ml[chas]","code_information":[{"code":"CP17640152376554643","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"88271 Genetics Molecular Cytology Unmc.","code_information":[{"code":"35088271UNMC","type":"CDM"},{"code":"310","type":"RC"},{"code":"88271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Lactoferrin, Fecal (Rps) Pspc","code_information":[{"code":"35083630P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Cannula Tripledam","code_information":[{"code":"1601672","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601672","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Cannula Dri-lok Distal Threaded 8.0mmx75mm","code_information":[{"code":"1602053","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Insufflation/pneumo Needle","code_information":[{"code":"1601756","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601756","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}]},{"description":"Methylprednisolone Sod Succ 1 Gm Vial[chas]","code_information":[{"code":"CP17640152376512830","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":98,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":59}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Complete blood cell count (CBC), automated","code_information":[{"code":"35085027","type":"CDM"},{"code":"301","type":"RC"},{"code":"85027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":97,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":58}]}]},{"description":"Hip Kit 7","code_information":[{"code":"1600484","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600484","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":97,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":58}]}]},{"description":"Strep B Latex","code_information":[{"code":"35087147","type":"CDM"},{"code":"300","type":"RC"},{"code":"87147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":96,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":58}]}]},{"description":"94760 Oximetry Single Charge","code_information":[{"code":"30094760","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":96,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":58}]}]},{"description":"40490-biopsy Of Lip-sc & Tech","code_information":[{"code":"14040490","type":"CDM"},{"code":"510","type":"RC"},{"code":"40490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":96,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":58}]}]},{"description":"Inhibin A (Dimer) (Rps) Pspc","code_information":[{"code":"35086336P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Community/work Reintegration Charges","code_information":[{"code":"32097537-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97537","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"11300 Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Trunk, Arms Or Legs; Lesion <0.5cm","code_information":[{"code":"14011300","type":"CDM"},{"code":"510","type":"RC"},{"code":"11300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"11305-shave Skin Lesion 0.5 Cm/<tech","code_information":[{"code":"14011305","type":"CDM"},{"code":"510","type":"RC"},{"code":"11305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"11306 Shave Les Sclp Nck Hnd Ft","code_information":[{"code":"14011306","type":"CDM"},{"code":"510","type":"RC"},{"code":"11306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"15271-skin Sub Graft Trnk/arm/leg-sc Tech","code_information":[{"code":"14015271","type":"CDM"},{"code":"761","type":"RC"},{"code":"15271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"20610-drain/inject Joint/bursasc Tech","code_information":[{"code":"14020610","type":"CDM"},{"code":"510","type":"RC"},{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"20612  Aspirate/inj Ganglion","code_information":[{"code":"14020612","type":"CDM"},{"code":"510","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"29086 Apply Finger Cast","code_information":[{"code":"14029086","type":"CDM"},{"code":"510","type":"RC"},{"code":"29086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"29105 Splint Long Arm Apply","code_information":[{"code":"14029105","type":"CDM"},{"code":"510","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"29505 Applic Of Long Leg Splint (Thigh To Ankle Or Toes) Charge","code_information":[{"code":"14029505","type":"CDM"},{"code":"510","type":"RC"},{"code":"29505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"69100 Biopsy External Ear Clinic Charge","code_information":[{"code":"14069100","type":"CDM"},{"code":"510","type":"RC"},{"code":"69100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"99212- Spec Clinic Visit Chg","code_information":[{"code":"140026","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Bladder Instillation Of Anticarcinogenic Agent (Including Retention Time).","code_information":[{"code":"14051720","type":"CDM"},{"code":"510","type":"RC"},{"code":"51720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Irrigation Bladder, Simple Technical Charge","code_information":[{"code":"14051700","type":"CDM"},{"code":"510","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Q3014 Telehealthsubsequent Charge","code_information":[{"code":"140Q3014","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Spec Clinic Visit Chg","code_information":[{"code":"140024","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Spec Clinic Visit Chg-25","code_information":[{"code":"140024-25","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Tenotomy, Open, Tendon Flexor; Toe, Single Tendon (Separate","code_information":[{"code":"14011900","type":"CDM"},{"code":"510","type":"RC"},{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"2108 Series Saggital Blade Aggressive Flared 29x1.24x83.5mm","code_information":[{"code":"1602134","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Needle Injection Cath 23ga","code_information":[{"code":"1601902","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601902","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":95,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":57}]}]},{"description":"Tibc Add-oniron & Ibc Pspc","code_information":[{"code":"35083550P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Testosterone Total Add On Charge 1","code_information":[{"code":"35084403FEDP","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Ca 19-9, Pspc","code_information":[{"code":"35086301P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Catheter Intrauterine","code_information":[{"code":"1601476","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601476","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Ethibond Excel Polyester Suture Mb47g","code_information":[{"code":"1602125","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602125","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Pronview Large Cushion Insert","code_information":[{"code":"1601840","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601840","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Suture Gortex Cv2 Thx-26 2n05a","code_information":[{"code":"1601753","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601753","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}]},{"description":"Clonidine 0.1 Mg/24 Hr Patch[chas]","code_information":[{"code":"CP17640152376466616","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817061004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":93,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":56}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Suture Xbraid Sz2 Wht/blu Mo6 Tpr","code_information":[{"code":"1602066","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":92,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"B Cell Subset, Pspc","code_information":[{"code":"35086356RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Cd19 Level, Pspc","code_information":[{"code":"35086357RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86357","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Cd3 Level, Pspc","code_information":[{"code":"35086355RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Cd56 Level, Pspc","code_information":[{"code":"35086359RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Gliadin Iga, Pspc","code_information":[{"code":"35083516AP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Gliadin Igg, Pspc","code_information":[{"code":"35083516GP","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"T Cell Ratio, Pspc","code_information":[{"code":"35086360RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Bili Neonatal","code_information":[{"code":"35082247","type":"CDM"},{"code":"301","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Bilirubin Direct","code_information":[{"code":"35082248","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Cryoglobulins Pspc","code_information":[{"code":"35082595P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Tricyclic Antidepressants, Urine Quant (Arup Via Rps) Pspc","code_information":[{"code":"350TCA","type":"CDM"},{"code":"301","type":"RC"},{"code":"80337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"35081001","type":"CDM"},{"code":"301","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Vdrl, Csf Pspc","code_information":[{"code":"35086592P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Small Joint Injection W/ultrasound","code_information":[{"code":"12520604","type":"CDM"},{"code":"360","type":"RC"},{"code":"20604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Q0091 Screeningpaptest","code_information":[{"code":"200Q0091","type":"CDM"},{"code":"521","type":"RC"},{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}]},{"description":"Atropine Ophthalmic 1% Sol [Chas]","code_information":[{"code":"CP17640152376444253","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylergonovine 0.2 Mg/ml1 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376516279","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517074020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":91,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":55}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Csf Tp Pspc","code_information":[{"code":"35084157P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Glucose, Csf Pspc","code_information":[{"code":"35082945P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Reverse T3 Pspc","code_information":[{"code":"35084482P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Vitamin C Pspc","code_information":[{"code":"35082180P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Catheter Epidural Kit","code_information":[{"code":"1600189","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600189","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Glove Isotoner Therapeutic Full-finger","code_information":[{"code":"1601579","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":90,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Candida Pcr Add On","code_information":[{"code":"35087480","type":"CDM"},{"code":"300","type":"RC"},{"code":"87480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"96523irrig Drug Delivery Deviceed Tech","code_information":[{"code":"13596523","type":"CDM"},{"code":"450","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Ca 15-3, Pspc","code_information":[{"code":"35086300P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Rh Type Arc","code_information":[{"code":"35086901ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"S-2,alican Blue, Pspc","code_information":[{"code":"35088313P","type":"CDM"},{"code":"300","type":"RC"},{"code":"88313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Vit B6, Plasma Pspc","code_information":[{"code":"35084207P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"99212spec Clinic Visit Chg-25","code_information":[{"code":"140026-25","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Cannula, Twist-in","code_information":[{"code":"1601722","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601722","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Ez-pap With Manometer","code_information":[{"code":"1601299","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601299","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Sexual Assault Kit","code_information":[{"code":"1601456","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601456","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":89,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":54}]}]},{"description":"Amoxicillin/pot Clav 600-42.9 Mg/5 Ml Susp[chas]","code_information":[{"code":"CP17640152376442012","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862053575","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"West Nile Ab, Igm Add On","code_information":[{"code":"35086788P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"Tissue Process, Level Iii Pspc","code_information":[{"code":"35088304P","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"Vap Cholesterol Pspc","code_information":[{"code":"35083701P","type":"CDM"},{"code":"300","type":"RC"},{"code":"83701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"West Nile Ab, Igm & Igg Pspc","code_information":[{"code":"35086789P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"11044deb Bone 20 Sw Cm/< -Sc Tech","code_information":[{"code":"14011044","type":"CDM"},{"code":"510","type":"RC"},{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"Tetanus And Diphtheria Toxoids (Td) Adsorbed, Preservative Free, For Use In Individuals 7 Yrs Poc","code_information":[{"code":"20090714-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"90714","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":33,"maximum":88,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":53}]}]},{"description":"Aborh Interp","code_information":[{"code":"35086901","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Aspartate Aminotransferase","code_information":[{"code":"35084450","type":"CDM"},{"code":"301","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Cholesterol Total","code_information":[{"code":"35082465","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Cannula Threaded","code_information":[{"code":"1601736","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601736","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Purwick Female External Catheter","code_information":[{"code":"1601998","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"29130 Applic Of Finger Splint; Static Charge","code_information":[{"code":"20029130","type":"CDM"},{"code":"521","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Propofol 10 Mg/ml100 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376534153","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155034543","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":87,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Celiac Disease Add On 1","code_information":[{"code":"35086255","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Opiates 1 Or More Pspc","code_information":[{"code":"35080365P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Blood Typing Abo","code_information":[{"code":"35086900","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Ana (W/ Pattern) Pspc","code_information":[{"code":"35086039P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Platelet Count","code_information":[{"code":"35085049","type":"CDM"},{"code":"305","type":"RC"},{"code":"85049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Uric Acid","code_information":[{"code":"35084550","type":"CDM"},{"code":"301","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"11311-shave Skin Lesion 0.6-1.0 Cmtech","code_information":[{"code":"14011311","type":"CDM"},{"code":"510","type":"RC"},{"code":"11311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Cannula Non-threaded Dri-lok 8.0mmx75mm","code_information":[{"code":"1602061","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602061","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}]},{"description":"Dexamethasone-tobramycin Opth 0.1%-0.3% Susp 2.5 Ml [Chas]","code_information":[{"code":"CP17640152376468232","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574403125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":86,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":52}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Sedimentation Rate","code_information":[{"code":"35085652","type":"CDM"},{"code":"300","type":"RC"},{"code":"85652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Ot Contrast Bath 15 Min.","code_information":[{"code":"32097034-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97034","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Attended E-stim Charges","code_information":[{"code":"31097032-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Immunization Admin-obs","code_information":[{"code":"10590471","type":"CDM"},{"code":"762","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Mask, Full Face Vented Sm","code_information":[{"code":"1600598","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600598","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Steri-cuff Dbl 18","code_information":[{"code":"1601376","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601376","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":86,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"90471 Immunization Admin 1 Vacced Tech","code_information":[{"code":"13590471","type":"CDM"},{"code":"450","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Abo Type Arc","code_information":[{"code":"35086900ARC","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Creatinine","code_information":[{"code":"35082565","type":"CDM"},{"code":"301","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Potassium Level","code_information":[{"code":"35084132","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Ot Evaluate Dysphagia Functionchas","code_information":[{"code":"32092610-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"92610","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Pt Ultrasound Assistant Units","code_information":[{"code":"31097035-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Ultrasound Charges","code_information":[{"code":"31097035-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"32552remove Lung Cathetersc Tech","code_information":[{"code":"14032552","type":"CDM"},{"code":"510","type":"RC"},{"code":"32552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Insertion Of Bladder Catheter, Complicated, Pro Fee","code_information":[{"code":"14051703","type":"CDM"},{"code":"510","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Sclerotherapy Of Fluid Collection","code_information":[{"code":"14011200","type":"CDM"},{"code":"510","type":"RC"},{"code":"11200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Optiflow Cannula Medium","code_information":[{"code":"1601953","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Wound Cleanser Dakin's Solu 1/4 Strength 16oz","code_information":[{"code":"1602034","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}]},{"description":"Adenosine 3 Mg/ml4 Ml Syringe[chas]","code_information":[{"code":"CP17640152376436831","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021030168","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Clonidine 100mcg/ml10 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376469834","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Diazepam 5 Mg/ml Inj Soln2 Ml [Chas]","code_information":[{"code":"CP17640152376467806","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dobutamine/d5w 250 Mg/250 Ml  Bag[chas]","code_information":[{"code":"CP17640152376474765","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Enoxaparin 100 Mg/ml Syringe[chas]","code_information":[{"code":"CP17640152376477050","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Leucovorin 10 Mg/ml10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376492752","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323063110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nicardipine 2.5 Mg/ml10 Ml [Chas]","code_information":[{"code":"CP17640152376521742","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nitroglycerin/d5w 0.2 Mg/ml250ml Bag[chas]","code_information":[{"code":"CP17640152376521173","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phytonadione 1 Mg/0.5 Ml Inj [Chas]","code_information":[{"code":"CP17640152376530053","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ropivacaine 1% Sol[chas]","code_information":[{"code":"CP17640152376542596","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin 1.75 G/350 Ml Ivpb [Chas]","code_information":[{"code":"CP17640152376567100","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":85,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":51}]}],"drug_information":{"unit":175,"type":"ML"}},{"description":"Assay Nephelmoetry [Chas] Addon 350mps","code_information":[{"code":"35083883P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Assay Of Protein Serum [Chas] Addon 350mps","code_information":[{"code":"35084155P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Hepatitis B Core Antibody; Total, Pspc","code_information":[{"code":"35086704P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Unmc Slide Consult, Pspc","code_information":[{"code":"35088323P","type":"CDM"},{"code":"310","type":"RC"},{"code":"88323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Chargein Town/out Of Town Charge Pt82","code_information":[{"code":"310PT82","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"90633 Havrixhepatitis A Ped/adol Vac 2 Dose [Chas]","code_information":[{"code":"20090633","type":"CDM"},{"code":"521","type":"RC"},{"code":"90633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"96523-port Central Line Flush Charge- Clinic","code_information":[{"code":"20096523","type":"CDM"},{"code":"521","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Nitroprusside 50 Mg/2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376522581","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069026101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":84,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cord Blood Eval Rh, Pspc","code_information":[{"code":"35086901CBP","type":"CDM"},{"code":"301","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Rh Type, Pspc","code_information":[{"code":"35086901P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"C-peptide Pspc","code_information":[{"code":"35084681P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Csf Cell Count Pspc","code_information":[{"code":"35089051P","type":"CDM"},{"code":"301","type":"RC"},{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Catecholamines, Total Ur Pspc","code_information":[{"code":"35082382P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Cell Count Body Fluid Pspc","code_information":[{"code":"35089050P","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Hematocrit","code_information":[{"code":"35085007","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Histone Antibody, Igg (Rps) Pspc","code_information":[{"code":"35083516HAB","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Unattended Electrical Therapyunattended Electrical Therapy Charge","code_information":[{"code":"31097014-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97014","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"29515-application Lower Leg Splint-sc Tech","code_information":[{"code":"14029515","type":"CDM"},{"code":"510","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Sensor Xp","code_information":[{"code":"1601815","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601815","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Hepatitis B Vaccine (G0010)","code_information":[{"code":"200G0010","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":83,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":50}]}]},{"description":"Body Fluid Ph Pspc","code_information":[{"code":"35083986P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"C1 Ester Inhib Pspc","code_information":[{"code":"35086160P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Cytology, Urine Pspc","code_information":[{"code":"35088108P","type":"CDM"},{"code":"311","type":"RC"},{"code":"88108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Growth Hormone Pspc","code_information":[{"code":"35083003P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Magnesium, Rbc Pspc","code_information":[{"code":"35083735PMRBC","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Abduction Pillow","code_information":[{"code":"1601663","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601663","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"67810 Incisional Biopsy Of Eyelid Skin Including Lid Margin","code_information":[{"code":"14067810","type":"CDM"},{"code":"510","type":"RC"},{"code":"67810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Screw  Cortical 3.5mm","code_information":[{"code":"1601767","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601767","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}]},{"description":"Arformoterol 15 Mcg/2 Ml Svn[chas]","code_information":[{"code":"CP17640152376446289","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":82,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":49}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Csf Albumin Add On Charge","code_information":[{"code":"35082042P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Cmv Antibody Igg, Pspc","code_information":[{"code":"35086644P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Eosinophil, Ur Pspc","code_information":[{"code":"35087205P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Intrinsic Factor Block Ab Pspc","code_information":[{"code":"35086340P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"10060 -Drainage Of Skin Abscess -Sc Tech","code_information":[{"code":"14010060","type":"CDM"},{"code":"510","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Suture Fiberwire Blue 2-0 T-13","code_information":[{"code":"1601962","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601962","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Tourniquet Cuff Single 12 Disp W/ Sleeve","code_information":[{"code":"1602058","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"G0101 Breast And Pap Examination","code_information":[{"code":"200G0101","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Succinylcholine 20 Mg/ml10 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376554639","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pamidronate Disodium 30 Mg Vial [Chas]","code_information":[{"code":"CP17640152376539384","type":"CDM"},{"code":"250","type":"RC"},{"code":"59923060110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":81,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Naloxone 0.4 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376518171","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756065810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Belly Bag Urine Collectio","code_information":[{"code":"1600073","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Heel Cups-silicone Large","code_information":[{"code":"1601500","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601500","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Knee Brace 24 Universal","code_information":[{"code":"1601440","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601440","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}]},{"description":"Ceftriaxone/dextrose 1 Gm/50 Ml Bag[chas]","code_information":[{"code":"CP17640152376451436","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264315311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Terbutaline 1 Mg/ml Sdv [Chas]","code_information":[{"code":"CP17640152376555368","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":80,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":48}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ana By Ifa (Rps) Pspc","code_information":[{"code":"350ANAP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Annatto Seed, Ige Pspc","code_information":[{"code":"35086003AP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Potassium Pspc","code_information":[{"code":"35084132P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Pt Attended E-stim Assistant Units","code_information":[{"code":"31097032-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"30905-tech Control Of Nose Bleed","code_information":[{"code":"14030905","type":"CDM"},{"code":"510","type":"RC"},{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"31231-dx Nasal Endoscopy-sc Tech","code_information":[{"code":"14031231","type":"CDM"},{"code":"510","type":"RC"},{"code":"31231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Monopolar Cable","code_information":[{"code":"1600621","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600621","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Screw Cancellous 4.0 Fully Thread","code_information":[{"code":"1601888","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601888","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Screw Cancellous 4.ommd","code_information":[{"code":"1601768","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1601768","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Theracath Epidural Cath","code_information":[{"code":"1601140","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":79,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Mannitol 20% Sol[chas]","code_information":[{"code":"CP17640152376505157","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990771503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Blood Urea Nitrogen","code_information":[{"code":"35084520","type":"CDM"},{"code":"301","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Calcium Level","code_information":[{"code":"35082310","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Lactate Dehydrogenase","code_information":[{"code":"35083615","type":"CDM"},{"code":"301","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Telemedicine Fee","code_information":[{"code":"145Q3014","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Ot 97546 Additional Hours","code_information":[{"code":"32097546-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97546","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Applic Of Short Arm Splint (Forearm To Hand); Static Charge","code_information":[{"code":"14029125","type":"CDM"},{"code":"510","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Catheter Coude 20fr 30cc 3way","code_information":[{"code":"1601572","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601572","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Compression Bandage System4 Layer","code_information":[{"code":"1601580","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601580","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Edema Wear Stocking Med","code_information":[{"code":"1601895","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601895","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Edema Wear Stocking Sm","code_information":[{"code":"1601894","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601894","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}]},{"description":"Atropine 1 Mg/ml1 Ml Sdv 2 [Chas]","code_information":[{"code":"CP17640152376441912","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":78,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":47}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vap Triglyceride Pspc","code_information":[{"code":"35084478P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Alkaline Phosphatase","code_information":[{"code":"35084075","type":"CDM"},{"code":"301","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Cinnamon Ige Allergen Pspc","code_information":[{"code":"35086003CP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Protein S Ag Pspc","code_information":[{"code":"35085305P","type":"CDM"},{"code":"302","type":"RC"},{"code":"85305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Rubeola Ab Igg Pspc","code_information":[{"code":"35086765PR","type":"CDM"},{"code":"302","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Respiratory Region Ix, Great Plains (Ibt) Pspc","code_information":[{"code":"35082785","type":"CDM"},{"code":"302","type":"RC"},{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Gram Stain Report","code_information":[{"code":"35087205","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Mechanical Tractionmechanical Traction Charge","code_information":[{"code":"31097012-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Subclavian Start Kit","code_information":[{"code":"1600900","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Suture Ethibond 5-0 V-40 Mb46","code_information":[{"code":"1601832","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601832","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Suture Fiberwire 2-0 7220","code_information":[{"code":"1600932","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600932","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"J1080 Testosterone Cypionat 200 Mg [Chas]","code_information":[{"code":"200J1080","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":77,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Fentanyl 50 Mcg/hr Patch[chas]","code_information":[{"code":"CP17640152376475664","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Hp Protein C Activity, Pspc","code_information":[{"code":"35085303HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Hp Protein S Free, Pspc","code_information":[{"code":"35085306HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Immunofixation, Urine [Monoclonal] [Chas] Pspc","code_information":[{"code":"35086335MP","type":"CDM"},{"code":"301","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Bnpb Natriuretic Peptide (Pspc)","code_information":[{"code":"35083880P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Blastomyces Antibody Pspc","code_information":[{"code":"35086612P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Glucose Random","code_information":[{"code":"35082947","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Prealbumin Pspc","code_information":[{"code":"35084134P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"20600drain/inj Joint/bursa W/o Us -Surg Tech","code_information":[{"code":"12520600","type":"CDM"},{"code":"360","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Achromioclav Splint Univ","code_information":[{"code":"1601405","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601405","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Catheter Angiocath 14ga X 5.5","code_information":[{"code":"1601776","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601776","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Catheter Angiocath 16ga X 5.5","code_information":[{"code":"1601947","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601947","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Catheter Coude 18fr 30cc 3way","code_information":[{"code":"1601574","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601574","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Compression Stocking Calf Bariatric","code_information":[{"code":"1602028","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Feeding Tube 8fr","code_information":[{"code":"1601276","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601276","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Gripper Needle 20 X 1 1/4","code_information":[{"code":"1601472","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601472","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Guide Wire With Trocar Tip","code_information":[{"code":"1602003","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Heel Cup Med Silicone","code_information":[{"code":"1600469","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600469","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Heel Cup Sm Silicone","code_information":[{"code":"1600470","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600470","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}]},{"description":"Piperacillin-tazobactam 3 G-0.375 G Iv Inj[chas]","code_information":[{"code":"CP17640152376533224","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piperacillin-tazobactam 4 G-0.5 G Rec Vial [Chas]","code_information":[{"code":"CP17640152376539300","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":76,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":46}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Nicotine & Metabolites, Serum Pspc","code_information":[{"code":"35080323PS","type":"CDM"},{"code":"300","type":"RC"},{"code":"80323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Beta Hydroxybutyrate Rps","code_information":[{"code":"35082010RPS","type":"CDM"},{"code":"301","type":"RC"},{"code":"82010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Occult Blood Stool 1","code_information":[{"code":"35082274","type":"CDM"},{"code":"301","type":"RC"},{"code":"82274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Sodium 24 Hr Ur Pspc","code_information":[{"code":"35084300P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Triglycerides","code_information":[{"code":"35084478","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Ot Paraffin Bath Therapy","code_information":[{"code":"32097018-GO","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Knee Immobilizer 22","code_information":[{"code":"1600537","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600537","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Tis-u-trap 12mm Curette","code_information":[{"code":"1601566","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601566","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"11732 Avulsion Of Nail Plate, Partial Or Complete, Simple; Each Addtl Nail Platecharge","code_information":[{"code":"20011732","type":"CDM"},{"code":"521","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":75,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":45}]}]},{"description":"Iron Pspciron & Ibc Pspc","code_information":[{"code":"35083540P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Cadmium, Blood Pspc","code_information":[{"code":"35082300P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Complement Component 1q Pspc","code_information":[{"code":"35086160QP","type":"CDM"},{"code":"301","type":"RC"},{"code":"86160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Latex Allergen Ige (Ibt) Pspc","code_information":[{"code":"35086003P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Progesterone Pspc","code_information":[{"code":"35084144P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Vari Zost Ab, Igg Pspc","code_information":[{"code":"35086787P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Paraffin Bath Chargeparaffin Bath Charge","code_information":[{"code":"31097018-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Cardioversion, Elective, Electrical Conversion Of Arrhythmia; Internalcharge","code_information":[{"code":"14596373","type":"CDM"},{"code":"260","type":"RC"},{"code":"96373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Needle Tougy 20ga X 6","code_information":[{"code":"1601820","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601820","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Steri-drape Large 129inx 99in","code_information":[{"code":"1602131","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":74,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"86147","code_information":[{"code":"35086147CLP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Hp Homocysteine, Blood Pspc","code_information":[{"code":"35083090HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Endomysial Antibody, Iga Pspc","code_information":[{"code":"35086256PET","type":"CDM"},{"code":"302","type":"RC"},{"code":"86256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"11732-avulsion Of Nail Plate, Partial Or Complete, Simple; Each Additional Nail Plate","code_information":[{"code":"14011732","type":"CDM"},{"code":"510","type":"RC"},{"code":"11732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Snare Hot/cold 15mm Disposable","code_information":[{"code":"1601999","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"Suture Ethilon 3-0 1663h","code_information":[{"code":"1600930","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600930","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}]},{"description":"90662 Influenza Virus Vaccine, Split-dose, Pf Hi Dose [Chas]","code_information":[{"code":"20090662","type":"CDM"},{"code":"636","type":"RC"},{"code":"90662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"90673influenza Virus Vac. Trivalent, Recom Dna, Pf, Im [Chas]","code_information":[{"code":"20090673","type":"CDM"},{"code":"636","type":"RC"},{"code":"90673","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":73,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":44}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"82952 Tolerance Test Ea Add Beyond 3 Specimens","code_information":[{"code":"35082952","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Carboxyhemoglobin Quant Pspc","code_information":[{"code":"35082375P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Cytology, Urine Pspc","code_information":[{"code":"35086335CYTO","type":"CDM"},{"code":"311","type":"RC"},{"code":"86335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Fungus Culture, Sputum Pspc","code_information":[{"code":"35087102PS","type":"CDM"},{"code":"306","type":"RC"},{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Reticulocyte Count 4","code_information":[{"code":"35085046","type":"CDM"},{"code":"305","type":"RC"},{"code":"85046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Strawberry Ige(ibt), Pspc","code_information":[{"code":"35086003SP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Fiberwire W/ Conventional Cutting Ndle","code_information":[{"code":"1601647","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601647","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"29085-apply Hand/wrist Cast-sc Tech","code_information":[{"code":"14029085","type":"CDM"},{"code":"510","type":"RC"},{"code":"29085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"58301 Removal Of Intrauterine Device (Iud)","code_information":[{"code":"14058301","type":"CDM"},{"code":"510","type":"RC"},{"code":"58301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Humidifer 1.2 Gal","code_information":[{"code":"1600493","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600493","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"K-wire 1.6mm","code_information":[{"code":"1601923","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601923","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Oxytip Sensor Allfit","code_information":[{"code":"1600687","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600687","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Waterboom Suction Strip","code_information":[{"code":"1601386","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601386","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Cefepime 1 Gm Vial  [Chas]","code_information":[{"code":"CP17640152376456638","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":72,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dextrose 50% Sol/50 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376464406","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ckmb, Fract Pspc","code_information":[{"code":"35082553P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Hp Anti Thrombin Iii, Pspc","code_information":[{"code":"35085300HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Afp, Tumor Marker Pspc","code_information":[{"code":"35082105P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Beta-2 Microglobulin (Rps) Pspc","code_information":[{"code":"35082232P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Cholinester Rbc Pspc","code_information":[{"code":"35082482P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Urinalysis test","code_information":[{"code":"35081003","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Vitamin A Pspc","code_information":[{"code":"35084590P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Urinalysis test","code_information":[{"code":"99981003","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Gstrostomy Tube 20fr","code_information":[{"code":"1600457","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600457","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Stat Padz Pediatric","code_information":[{"code":"1601337","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601337","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Suture Silk Black 8 X 18 Sh-1","code_information":[{"code":"1601864","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601864","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"98925 Omt 1-2 Body Regions-clinic","code_information":[{"code":"20098925","type":"CDM"},{"code":"521","type":"RC"},{"code":"98925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}]},{"description":"Nystatin Powder 15 Gm Bottle[chas]","code_information":[{"code":"CP17640152376523261","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Naloxone 1 Mg/ml2 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376517189","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":71,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":43}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Myoglobin, Urine (Rps) Pspc","code_information":[{"code":"35083874P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":70,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"Knee Brace 19 Universal","code_information":[{"code":"1601439","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601439","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":70,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"Pump Chemo Infustion Elastomeric 270ml","code_information":[{"code":"1602023","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":70,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"11720-debridement Of Nail(s) By Any Method(s); 1 To 5","code_information":[{"code":"20011720-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"11720","type":"CPT","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":26,"maximum":70,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"Methylprednisolone Acetate 80 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376517446","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":70,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Beta-2 Microglobulin, Urine (Rps) Pspc","code_information":[{"code":"35082232PU","type":"CDM"},{"code":"301","type":"RC"},{"code":"82232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"Pin Steinmann","code_information":[{"code":"1601656","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601656","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"Stat Pad  Adult","code_information":[{"code":"1600859","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600859","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}]},{"description":"90682 Influenza Quadrivalent Vaccine Pf [Chas]","code_information":[{"code":"20090682","type":"CDM"},{"code":"636","type":"RC"},{"code":"90682","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Etomidate 2 Mg/ml Sdv [Chas]","code_information":[{"code":"CP17640152376471395","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Vancomycin 1 G/200 Ml Ivpb [Chas]","code_information":[{"code":"CP17640152376556460","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Adenosine 3 Mg/ml2 Ml [Chas]","code_information":[{"code":"CP17640152376432075","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323065189","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":69,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":42}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Beta Hcg, Tmr Mrkr Pspc","code_information":[{"code":"35084702P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Gastric Occult Blood 3","code_information":[{"code":"35082271","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Phosphorus Level","code_information":[{"code":"35084100","type":"CDM"},{"code":"301","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Retic Count Pspc","code_information":[{"code":"35085046P","type":"CDM"},{"code":"301","type":"RC"},{"code":"85046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"35085730P","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"64420-inj Anes Ag/steroid, Intercostal Nerve, Sing Lev-surg Tech","code_information":[{"code":"12564420","type":"CDM"},{"code":"360","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Chas Tomo Mammo Diagnostic Bilateral/unilateral","code_information":[{"code":"360G0279","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Chas Tomo Mammo Screening Bilateral","code_information":[{"code":"36077063B","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Catheter Angiocath 14ga 3.25","code_information":[{"code":"1601777","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601777","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Ez-stabilizer","code_information":[{"code":"1601557","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601557","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Needle Blunt Coude 20g X 4.5","code_information":[{"code":"1601890","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601890","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Needle Blunt Coude 20g X 6","code_information":[{"code":"1601891","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601891","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Dtap Diphtheria/pertussis, Acellular/tetanus Vaccine Dtap Under 7 Yrs","code_information":[{"code":"20090700","type":"CDM"},{"code":"521","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"Declot Vascular Device.","code_information":[{"code":"20036593","type":"CDM"},{"code":"521","type":"RC"},{"code":"36593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":68,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":41}]}]},{"description":"B Pertussis Igg","code_information":[{"code":"35086615GP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"B Pertussis Igm","code_information":[{"code":"35086615MP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Ccp Igg Ab Pspc","code_information":[{"code":"35086200P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Immunoglob G (Igg) Pspc","code_information":[{"code":"35082784P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Immunoglob G (Igg) Subclass 1 Pspc","code_information":[{"code":"35082787RPS","type":"CDM"},{"code":"302","type":"RC"},{"code":"82787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Zinc, Serum Or Plasma (Rps) Pspc","code_information":[{"code":"35084630P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Catheter Coude 16fr 30cc 3-way","code_information":[{"code":"1602113","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Suture Vicryl 2-0 Undyed 12 X 18 Strands","code_information":[{"code":"1601861","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601861","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Gi Cocktail Clinic Charge","code_information":[{"code":"22489364","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP22489364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"90472-immunization Admis Each Add-tech","code_information":[{"code":"14590472","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Abducted Thumb Supp Lg/lt","code_information":[{"code":"1601363","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601363","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Catheter Coude 24fr 5cc","code_information":[{"code":"1601332","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601332","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}]},{"description":"Epinephrine 1:1,0001 Mg/ml [Chas]","code_information":[{"code":"CP17640152376472191","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Amiodarone 900 Mg / 18 Ml Sol [Chas]","code_information":[{"code":"CP17640152376448959","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457015318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Azithromycin 200mg/5ml Susp[chas]","code_information":[{"code":"CP17640152376443510","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806014932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Enoxaparin 60 Mg/0.6 Ml Syringe[chas]","code_information":[{"code":"CP17640152376471653","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":67,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":40}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Catheter Coude I.c. 12fr 5cc","code_information":[{"code":"1601889","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601889","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":66,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Lactated Ringer 3000ml Irr","code_information":[{"code":"1602129","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":66,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Spinal Tray","code_information":[{"code":"1600843","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":66,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Sodium Chloride 0.9% With Kcl 20 Meq/l Intravenous Solution 1000 Ml[chas]","code_information":[{"code":"CP17640152376546451","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338069104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}],"drug_information":{"unit":9,"type":"ML"}},{"description":"Alanine Aminotransferase","code_information":[{"code":"35084460","type":"CDM"},{"code":"301","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Albumin Level","code_information":[{"code":"35082040","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Hepatitis A Ab, Total Pspc","code_information":[{"code":"35086708P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"51701insert Bladder Catheter -Tech","code_information":[{"code":"10551701","type":"CDM"},{"code":"110","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Pt Orthotic Mgmt/train Establish Charge","code_information":[{"code":"31097763","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"11301 Shave Epidermal Les Sngl","code_information":[{"code":"14011301","type":"CDM"},{"code":"510","type":"RC"},{"code":"11301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"11310-shave Skin Lesion 0.5 Cm/<tech","code_information":[{"code":"14011310","type":"CDM"},{"code":"510","type":"RC"},{"code":"11310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"28820amputation Of Toesc Tech","code_information":[{"code":"14028820","type":"CDM"},{"code":"510","type":"RC"},{"code":"28820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"64450-n Block Other Peripheral-sc Tech","code_information":[{"code":"14064450","type":"CDM"},{"code":"510","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abd Thumb Support Lt  Med","code_information":[{"code":"1600008","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abdominal Binder 52-72","code_information":[{"code":"1601274","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abducted Thumb Supp Lg/rt","code_information":[{"code":"1601364","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abducted Thumb Supp Md/rt","code_information":[{"code":"1601362","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601362","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abducted Thumb Supp Sm/lt","code_information":[{"code":"1601360","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601360","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Abducted Thumb Supp Sm/rt","code_information":[{"code":"1601361","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601361","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}]},{"description":"Ampicill/sulbact 3 Gm Vial[chas]","code_information":[{"code":"CP17640152376445816","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Hydralazine  20 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376489427","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tobramycin Ophthalmic 0.3% Sol5 Ml [Chas]","code_information":[{"code":"CP17640152376559131","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332051805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":65,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":39}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"90472-immunization Admin Each Add-ip","code_information":[{"code":"10590472","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Immunization Admin Ea Add Ed Charge","code_information":[{"code":"13590472","type":"CDM"},{"code":"450","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Anchovy Ige Pspc","code_information":[{"code":"35086003ANCP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Blackberry Ige Pspc","code_information":[{"code":"35086003BKBYP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Blueberry Ige Pspc","code_information":[{"code":"35086003BLBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Cranberry Ige Pspc","code_information":[{"code":"35086003CRNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Dnase-b Antibody, Pspc","code_information":[{"code":"35086215P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Flaxseed Ige Pspc","code_information":[{"code":"35086003FP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Gulf Flounder Ige Pspc","code_information":[{"code":"35086003GFP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Kiwi Fruit Ige Pspc","code_information":[{"code":"35086003KWFP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Mackerel Ige Pspc","code_information":[{"code":"35086003MSCP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Papaya Ige Pspc","code_information":[{"code":"35086003PAYP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Poppy Seed Ige Pspc","code_information":[{"code":"35086003POPP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Sardine/pilchard Ige Pspc","code_information":[{"code":"35086003SARP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Squid Ige Pspc","code_information":[{"code":"35086003SQP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Sunflower Seed Ige Pspc","code_information":[{"code":"35086003SSDP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Tilapia Ige Pspc","code_information":[{"code":"35086003TLP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Whey Ige Pspc","code_information":[{"code":"35086003WHYP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Biopsy Frcp Allgtr Jaw","code_information":[{"code":"1600845","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600845","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Derma Flex Tissue Adhesiv","code_information":[{"code":"1600305","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP1600305","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Ltx Closed Cath Tr 16fr","code_information":[{"code":"1600575","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600575","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Silver Alginate Dressing Mckesson 4 X 8","code_information":[{"code":"1602116","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Hemophilus Influenza B Vaccine (Hib), Hboc Conjugate (4 Dose), Im Poc","code_information":[{"code":"20090645","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP20090645","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Inj Iron Dextran","code_information":[{"code":"200J1750","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Strapping; Shoulder (Eg, Velpeau) Charge","code_information":[{"code":"20029240","type":"CDM"},{"code":"521","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Fluconazole 400 Mg/200 Ml Iv Premix [Chas]","code_information":[{"code":"CP17640152376489170","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":64,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Insulin, Total Pspc","code_information":[{"code":"35083525P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Pinworms Pspc","code_information":[{"code":"35087172P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Catheter Coude 14 Fr 5cc","code_information":[{"code":"1601589","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601589","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Catheter Coude 18fr  5cc","code_information":[{"code":"1601266","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601266","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Catheter Coude 20fr 5cc","code_information":[{"code":"1601331","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601331","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Coude Cath W/ 5cc 16fr","code_information":[{"code":"1600290","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600290","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Pavlik Harness Medium","code_information":[{"code":"1601454","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601454","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Pavlik Harness Small","code_information":[{"code":"1601450","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601450","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Ring Adapt Flat Skin Barrier","code_information":[{"code":"1601845","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601845","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":63,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":38}]}]},{"description":"Ammonia Pspc","code_information":[{"code":"35082140P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Cytology, Pleural Fluid Pspc","code_information":[{"code":"35088104P","type":"CDM"},{"code":"311","type":"RC"},{"code":"88104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Eosinophils Sputum, Cyto Pspc","code_information":[{"code":"35089190P","type":"CDM"},{"code":"300","type":"RC"},{"code":"89190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Hematocrit","code_information":[{"code":"35085014","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Phos (Inorg) Pspc","code_information":[{"code":"35084100P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Rbc Antibody Titer Pspc","code_information":[{"code":"35086886P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Transferrin (Rps) Pspc","code_information":[{"code":"35084466P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Lexiscan 0.4mg Charge","code_information":[{"code":"1651442","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"29425-applic Short Leg Cast-walk/ambu Type-sc Tech","code_information":[{"code":"14029425","type":"CDM"},{"code":"510","type":"RC"},{"code":"29425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"90746 Hepatitis B Pediatric Vaccine [Chas]","code_information":[{"code":"20090744","type":"CDM"},{"code":"521","type":"RC"},{"code":"90744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}]},{"description":"Acyclovir 50 Mg/ml10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376432216","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":62,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":37}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Concentration, Infect Agent Pspc Add On Charge","code_information":[{"code":"35087015P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Protein Electrophoresis, Urine [Monoclonal] [Chas] Pspc","code_information":[{"code":"35084166MP","type":"CDM"},{"code":"301","type":"RC"},{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Serum Albumin Add On Charge","code_information":[{"code":"35082040P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Thyroid Microsomal Ab Pspc","code_information":[{"code":"35086376TP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Alp Isoenzymes Pspc","code_information":[{"code":"35084075P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Blood Culture Pspc","code_information":[{"code":"35087040P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Occult Blood Stool Diagnostic 1","code_information":[{"code":"CP17640151596092181","type":"CDM"},{"code":"CP17640151596092181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Occult Blood Stool Screen 1","code_information":[{"code":"35082270","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Protein Total","code_information":[{"code":"35084155","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"11730-removal Of Nail Plate-sc Tech","code_information":[{"code":"14011730","type":"CDM"},{"code":"510","type":"RC"},{"code":"11730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Shoulder Arthroscopy Abduction System","code_information":[{"code":"1601823","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601823","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Suction Coagulator 10fr","code_information":[{"code":"1601379","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601379","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Tube Set","code_information":[{"code":"1601173","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Synvisc (J7325)","code_information":[{"code":"200J732516","type":"CDM"},{"code":"521","type":"RC"},{"code":"J7325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":61,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Nhi Pacemaker Checks","code_information":[{"code":"14093280","type":"CDM"},{"code":"929","type":"RC"},{"code":"93280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"97803 Med Nutrition Therapyre Charge","code_information":[{"code":"17097803","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Pt Orthotic Mgmt/train Est Assist Units","code_information":[{"code":"31097763-CQ","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"CPT","modifier":"CQ"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CQ"],"minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"64492inj Paravert F Inj C/t 3 Or More Levtech","code_information":[{"code":"12564492","type":"CDM"},{"code":"360","type":"RC"},{"code":"64492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"69200-clear Out Ear Canal-sc Tech","code_information":[{"code":"14069200","type":"CDM"},{"code":"510","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Abducted Thumb Supp Xl/lt","code_information":[{"code":"1601374","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601374","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Ankle Air Brace Left","code_information":[{"code":"1601407","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601407","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Catheter Thoracic 12fr","code_information":[{"code":"1601575","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601575","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Monsel Soln","code_information":[{"code":"1601619","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601619","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}]},{"description":"Fentanyl 12 Mcg/hr Patch[chas]","code_information":[{"code":"CP17640152376477758","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042347","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Fentanyl 25 Mcg/hr Patch[chas]","code_information":[{"code":"CP17640152376474917","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Vancomycin 125 Mg Cap [Chas]","code_information":[{"code":"CP17640152376561730","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155085878","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Epinephrine 0.1 Mg/ml10 Ml Syringe[chas]","code_information":[{"code":"CP17640152376475446","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levetiracetam 100 Mg/ml5 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376499977","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Magnesium Sulfate 2 G/50 Ml-sterile Water Premix [Chas]","code_information":[{"code":"CP17640152376502669","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121171902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Sulfamethoxazole-trimethoprim 80 Mg-16 Mg/ml10 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376557497","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703951403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":60,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":36}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Amerigel Hydrogel Wound Dressing","code_information":[{"code":"1601867","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601867","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":59,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Suture Gore-tex 36 Thx-36 Taper","code_information":[{"code":"1601870","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601870","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":59,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Suture:ethibond 0 #Cx41g","code_information":[{"code":"1600982","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":59,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Office/outpatient Visit Level 1 Established99211","code_information":[{"code":"20099211","type":"CDM"},{"code":"521","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":59,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Dopamine/d5w 400 Mg/250 Ml Bag[chas]","code_information":[{"code":"CP17640152376472440","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":59,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Triamcinolone 10 Mg/ml5 Ml Mdv1 Ml [Chas]","code_information":[{"code":"CP17640152376557298","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Igg4 Food Panel Ii Ibt, Pspc","code_information":[{"code":"35086001P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Drug Abuse Scr 4  Pspc","code_information":[{"code":"35080307","type":"CDM"},{"code":"301","type":"RC"},{"code":"CP35080307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Ionized Calcium Pspc","code_information":[{"code":"35082330P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Pap Liquid Based-surepath Pspc","code_information":[{"code":"35088142P","type":"CDM"},{"code":"311","type":"RC"},{"code":"88142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}]},{"description":"Orphenadrine 30 Mg/ml2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376526761","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021065102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Sumatriptan 6 Mg/0.5 Ml Subq [Chas]","code_information":[{"code":"CP17640152376554321","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143963805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tranexamic Acid 100 Mg/ml10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376556502","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sodium Chloride 0.45% Iv Sol 1000 Ml[chas]","code_information":[{"code":"CP17640152376545026","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":45,"type":"ML"}},{"description":"Dextrose 5%/0.9% Sodium Chl 1000 Ml Bag[chas]","code_information":[{"code":"CP17640152376460246","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":58,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":35}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Activated Charcoal 240 Ml[chas]","code_information":[{"code":"CP17640152376434585","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689020108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":240,"type":"ML"}},{"description":"Dapagliflozin 10 Mg Tab [Chas]","code_information":[{"code":"CP17640152376465417","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dextrose 5%/lactated Ringers 1000 Ml Bag[chas]","code_information":[{"code":"CP17640152376460690","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Rivaroxaban 10 Mg Tab [Chas]","code_information":[{"code":"CP17640152376543559","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Scopolamine 1 Mg Transderm Er Film[chas]","code_information":[{"code":"CP17640152376544206","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742050504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Apolipoprotein B (Rps) Pspc","code_information":[{"code":"35082172P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Crp, Cardiac Pspc","code_information":[{"code":"35086141P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Hiv 1/2 Abs Pspc","code_information":[{"code":"35087389P","type":"CDM"},{"code":"301","type":"RC"},{"code":"87389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Ssa (52kd And 60kd) Ab (Rps) Pspc","code_information":[{"code":"35086235PA","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Sodium Level","code_information":[{"code":"35084295","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"64491inj Paravert F Inj C/t 2 Levtech","code_information":[{"code":"12564491","type":"CDM"},{"code":"360","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Bur Egg 4.0mm","code_information":[{"code":"1601875","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601875","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Connect Tube W/drain Bag","code_information":[{"code":"1601320","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601320","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"J1050 Medroxyprogesterone 150mg [Chas]","code_information":[{"code":"200J1050","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Dextrose 5% With 0.45% Nacl Intravenous Solution [Chas]","code_information":[{"code":"CP17640152376467353","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338008504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Atropine 1 Mg/ml1 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376448311","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517101025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dextrose 5%/water  1000 Ml Bag[chas]","code_information":[{"code":"CP17640152376466706","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338001704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Lactated Ringers 1000 Ml Bag[chas]","code_information":[{"code":"CP17640152376492975","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":57,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sodium Chloride 0.9% Iv Sol 1000 Ml[chas]","code_information":[{"code":"CP17640152376546262","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338004904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}],"drug_information":{"unit":9,"type":"ML"}},{"description":"92511-nasopharyngoscopy-sc Tech","code_information":[{"code":"14092511","type":"CDM"},{"code":"510","type":"RC"},{"code":"92511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Abducted Thumb Supp Xl/rt","code_information":[{"code":"1601373","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601373","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Ankle Air  Brace Right","code_information":[{"code":"1601494","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601494","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Needle Guide Endocavity","code_information":[{"code":"1601997","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"J1010 Methylprednisolone Acetate 80 Mg Sdv [Chas]","code_information":[{"code":"200J1040","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"11307-shaving Of Epidermal Or Dermal Lesion, Single Lesion, Scalp, Neck, Hands, Feet, Genitalia; Les","code_information":[{"code":"14011307","type":"CDM"},{"code":"510","type":"RC"},{"code":"11307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":56,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":34}]}]},{"description":"Levetiracetam 1000 Mg/100 Ml-nacl 0.75% [Chas]","code_information":[{"code":"CP17640152376502889","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ebv Nuclear Ab Add On Charge","code_information":[{"code":"35086664P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Ebv Viral Capsid Ab Igg Add On Charge","code_information":[{"code":"35086665G","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Ebv Viral Capsid Ab Igm Add On Charge","code_information":[{"code":"35086665M","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Hp Fibrinogen Pspc","code_information":[{"code":"35085384HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"35085610HP","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"35085730HP","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Hp Thrombin Time, Pspc","code_information":[{"code":"35085670HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Catheter Tip Culture Pspc","code_information":[{"code":"35087070P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Ceruloplasmin Pspc","code_information":[{"code":"35082390P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Epst-barr Acute Pspc","code_information":[{"code":"35086663P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Glucose Poc (Lab)","code_information":[{"code":"350000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP350000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Non-insurance Draw","code_information":[{"code":"35036415N","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Panorama Client Bill","code_information":[{"code":"350PANORAMA","type":"CDM"},{"code":"300","type":"RC"},{"code":"99999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"97802 Med Nutrition Therapyint Charge","code_information":[{"code":"17097802","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Nasal Airway Kit26fr-34fr","code_information":[{"code":"1600627","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600627","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Tape Hytape 2","code_information":[{"code":"1601482","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601482","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Topical Tissue Adhesive Pen 1.0ml","code_information":[{"code":"1602031","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}]},{"description":"Meropenem 1 Gm Sdv[chas]","code_information":[{"code":"CP17640152376500516","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dextrose 5% With 0.45% Nacl And Kcl 20 Meq/l Intravenous Solution [Chas]","code_information":[{"code":"CP17640152376468856","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sodium Chloride 0.45% With Kcl 20 Meq/l Intravenous Solution Sodium Chloride 0.45% With Kcl 20 Meq/l Sol[chas]","code_information":[{"code":"CP17640152376546518","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Cephalexin 250 Mg/5 Ml Susp[chas]","code_information":[{"code":"CP17640152376452219","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Sodium Bicarbonate 4.2%  [Chas]","code_information":[{"code":"CP17640152376541693","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409553434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":55,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":33}]}],"drug_information":{"unit":42,"type":"EA"}},{"description":"Anaerobic Culture Pspc","code_information":[{"code":"35087075P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Ige (Ibt) Pspc","code_information":[{"code":"35082785P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Parasite Id (Rps) Pspc","code_information":[{"code":"35087168R","type":"CDM"},{"code":"306","type":"RC"},{"code":"87168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"C-arm Drape","code_information":[{"code":"1600148","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600148","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Shaver Electric Disposabl","code_information":[{"code":"1601554","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601554","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Trocar Tipped Femoral Eyeloop Drill12 X 3/32","code_information":[{"code":"1602071","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602071","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Heparin /D5w  100 Units/ml â 250 Ml Bag[chas]","code_information":[{"code":"CP17640152376489658","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409452030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":54,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"87324","code_information":[{"code":"35087324P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Hp Russell Viper Venom","code_information":[{"code":"35085613HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"11102 Tangetial Biopsy, Single Lesion","code_information":[{"code":"14011102","type":"CDM"},{"code":"510","type":"RC"},{"code":"11102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Biopsy Needle","code_information":[{"code":"1600083","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600083","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"J0696 Ceftriaxone 500 Mg Vial [Chas]","code_information":[{"code":"200J0696500","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}]},{"description":"Betamethasone  6 Mg/ml 5 Ml Mdv1 Ml[chas]","code_information":[{"code":"CP17640152376446695","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Thiamine 100 Mg/ml 2 Ml Mdv 1 Ml [Chas]","code_information":[{"code":"CP17640152376553954","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":53,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":32}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Rpr, Quantitative (Rps) Pspc","code_information":[{"code":"35086593P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Blade Myringotomy Narrow","code_information":[{"code":"1600094","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600094","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Cath Foley Latex 30cc24fr","code_information":[{"code":"1600170","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600170","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Cath Irr Latex 30cc  22fr","code_information":[{"code":"1600173","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Wound Drainage Colect 4x8","code_information":[{"code":"1601251","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601251","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Atropine 0.1 Mg/ml10 Ml Syringe[chas]","code_information":[{"code":"CP17640152376442032","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sodium Bicarbonate 8.4% Sol[chas]","code_information":[{"code":"CP17640152376546792","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":84,"type":"EA"}},{"description":"Enoxaparin 40 Mg/0.4 Ml Syringe[chas]","code_information":[{"code":"CP17640152376474937","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":52,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Dextrose 5%/water  500 Ml Bag[chas]","code_information":[{"code":"CP17640152376461360","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338006620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Almond Ige Pspc","code_information":[{"code":"35086003ALP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Apple Ige Pspc","code_information":[{"code":"35086003APP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Avocado Ige Pspc","code_information":[{"code":"35086003AVP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Banana Ige Pspc","code_information":[{"code":"35086003BANP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Bass, Black (Sea Bass) Ige Pspc","code_information":[{"code":"35086003BBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Beef Ige Pspc","code_information":[{"code":"35086003BFP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Brazil Nut Ige Pspc","code_information":[{"code":"35086003BNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Casein Ige Pspc","code_information":[{"code":"35086003CSNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Cashew Nut Ige Pspc","code_information":[{"code":"35086003CNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Catfish Ige Pspc","code_information":[{"code":"35086003CFP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Cherry Ige Pspc","code_information":[{"code":"35086003CHP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Chicken Meat Ige Pspc","code_information":[{"code":"35086003CKNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Chloride Level","code_information":[{"code":"35082435","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Clam Ige Pspc","code_information":[{"code":"35086003CLMP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Codfish Ige Pspc","code_information":[{"code":"35086003CDP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Cow's Milk Ige Pspc","code_information":[{"code":"35086003CWMP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Crab Ige Pspc","code_information":[{"code":"35086003CBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Drugs Of Abuse Screen 10 Panel, (Medtox) Pspc","code_information":[{"code":"35080301MT","type":"CDM"},{"code":"301","type":"RC"},{"code":"80301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Eggwhite Ige Pspc","code_information":[{"code":"35086003EGP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Grape Ige Pspc","code_information":[{"code":"35086003GRPP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Hake Ige Pspc","code_information":[{"code":"35086003HKP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Hazelnut Ige Pspc","code_information":[{"code":"35086003HP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Herring Ige Pspc","code_information":[{"code":"35086003HRP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Lemon Ige Pspc","code_information":[{"code":"35086003LMNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Lime Ige Pspc","code_information":[{"code":"35086003LMEP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Lobster Ige Pspc","code_information":[{"code":"35086003LBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Macadamia Nut Ige Pspc","code_information":[{"code":"35086003MACNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Mango Fruit Ige Pspc","code_information":[{"code":"35086003MNGP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Melona Ige Pspc","code_information":[{"code":"35086003MLNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Orange Ige Pspc","code_information":[{"code":"35086003ORAP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Peach Ige Pspc","code_information":[{"code":"35086003PCHP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Pear Ige Pspc","code_information":[{"code":"35086003PEARP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Pecan Nut Ige Pspc","code_information":[{"code":"35086003PCNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Perch, Ocean Ige Pspc","code_information":[{"code":"35086003OP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Pineapple Ige Pspc","code_information":[{"code":"35086003PNPP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Pistachio Ige Pspc","code_information":[{"code":"35086003PSTP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Potato Ige Pspc","code_information":[{"code":"35086003POTP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Raspberry Ige Pspc","code_information":[{"code":"35086003RSPP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Red Snapper Ige Pspc","code_information":[{"code":"35086003RSNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Salmon Ige Pspc","code_information":[{"code":"35086003SLMP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Scallop Ige Pspc","code_information":[{"code":"35086003SCP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Shrimp Ige Pspc","code_information":[{"code":"25086003SHP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Sole Ige Pspc","code_information":[{"code":"35086003SOLP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Soybean Ige Pspc","code_information":[{"code":"35086003SBP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Tomato Ige Pspc","code_information":[{"code":"35086003TOMP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Trout Ige Pspc","code_information":[{"code":"35086003TRP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Tuna Ige Pspc","code_information":[{"code":"35086003TUP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Walnut Ige Pspc","code_information":[{"code":"35086003WLNP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Watermelon Ige Pspc","code_information":[{"code":"35086003WTRP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Suture Vicyrl 3-0 Sh","code_information":[{"code":"1600957","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600957","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}]},{"description":"Acetaminophen 1gm -1000 Mg/100 Ml [Chas]","code_information":[{"code":"CP17640152376433763","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Methylprednisolone Acetate 40 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376518717","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylprednisolone Sod Suc 125 Mg Vial[chas]","code_information":[{"code":"CP17640152376514927","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Naloxone 4 Mg/0.1 Ml Spray [Chas]","code_information":[{"code":"CP17640152376519558","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Piperacillin-tazobactam 2 G-0.25 G Rec [Chas]","code_information":[{"code":"CP17640152376535528","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":51,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":31}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Catheter Thoracic 10fr","code_information":[{"code":"1601914","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601914","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Clavicle Bace Xxlg Padded","code_information":[{"code":"1601415","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601415","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Oxysensoriii N-25 Neo Adu","code_information":[{"code":"1600686","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1600686","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Reloads Linear Cutter 34m","code_information":[{"code":"1601535","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601535","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Albuterol Sulf 8 Gm Inhaler[chas]","code_information":[{"code":"CP17640152376430616","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Promethazine 12.5 Mg Supp[chas]","code_information":[{"code":"CP17640152376538807","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713053612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Promethazine 25 Mg Supp[chas]","code_information":[{"code":"CP17640152376530596","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Calcium Gluconate 100 Mg/ml10 Ml Sdv[chas]","code_information":[{"code":"CP17640152376450108","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":50,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Drug Screen Amphetamines 1/2 Pspc","code_information":[{"code":"35080324P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Ige (Arup) Pspc","code_information":[{"code":"35082785RP","type":"CDM"},{"code":"302","type":"RC"},{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Methylenedioxyamphetamines Pspc","code_information":[{"code":"35080359P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80359","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Fungus Culture: Skin, Hair, Nails Pspc","code_information":[{"code":"35087101P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Hemoglobin","code_information":[{"code":"35085018","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"20552-inj Trigger Point 1/2 Muscle-sc Tech","code_information":[{"code":"14020552","type":"CDM"},{"code":"510","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"62370-anl Sp Inf Pump W/ Md Reprg & Fill -Sc Tech","code_information":[{"code":"14062370","type":"CDM"},{"code":"510","type":"RC"},{"code":"62370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Control Of Nosebleed Sc","code_information":[{"code":"14030901","type":"CDM"},{"code":"510","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"1.5% Glycine Irr 3000ml","code_information":[{"code":"1601752","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601752","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Cannula Universal Set","code_information":[{"code":"1601697","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601697","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Esmark Bandage 4x9'","code_information":[{"code":"1600376","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600376","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Knee Brace Multipanel 26","code_information":[{"code":"1601430","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601430","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Rhino Rocket Slimline Lg","code_information":[{"code":"1600768","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600768","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"96372  Therapeutic; Prophylactic, Or Diagnostic Injection, Subcutaneous Or Intramuscular","code_information":[{"code":"20096372","type":"CDM"},{"code":"521","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Cdl Examination","code_information":[{"code":"200CDL","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}]},{"description":"Calcium Chloride1000 Mg /10 Ml Syringe[chas]","code_information":[{"code":"CP17640152376454349","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Sodium Chloride 0.9% Iv Sol 500 Ml Excel Bag[chas]","code_information":[{"code":"CP17640152376541200","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338954304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":49,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":30}]}],"drug_information":{"unit":9,"type":"ML"}},{"description":"Norepinephrine 1 Mg/ml4 Ml [Chas]","code_information":[{"code":"CP17640152376521801","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991098317","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ankle Brace Universal","code_information":[{"code":"1601403","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601403","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}]},{"description":"Needle Decompression, 14ga X 3.25in","code_information":[{"code":"1602068","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602068","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}]},{"description":"Pump Tubing W/infusion Li","code_information":[{"code":"1600751","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}]},{"description":"Silver Alginate Dressing Mckesson 4 X 4-3/4","code_information":[{"code":"1602115","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602115","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}]},{"description":"Levofloxacin 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376503495","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904635261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Triamcinolone Acetonide 40 Mg/ml1 Ml Inj Susp[chas]","code_information":[{"code":"CP17640152376558863","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":29}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Bupivacaine-epinephrine 0.25%30 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376457562","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Mupirocin Topical 2%22 Gm Oin [Chas]","code_information":[{"code":"CP17640152376510684","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Urine Protein Ran/24 Hr (Rps) Pspc","code_information":[{"code":"35084156RPS","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Alcohol, Urine (Pspc)","code_information":[{"code":"35080320P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"D-dimer Pspc","code_information":[{"code":"35085379P","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Rubella Screen Pspc","code_information":[{"code":"35086762P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Ankle Brace Aso Xsmall","code_information":[{"code":"1601495","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Cath Irr Latex 30cc 18fr","code_information":[{"code":"1600174","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600174","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Catheter Thoracic 36fr","code_information":[{"code":"1601536","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601536","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Irc Sheaths","code_information":[{"code":"1600520","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Laparoscopic Tube Set","code_information":[{"code":"1600048","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Sensor Spo2 Infant","code_information":[{"code":"1600809","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Umbilical Cath","code_information":[{"code":"1601183","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601183","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Uro Catcher Ii","code_information":[{"code":"1601213","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601213","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Ciprofloxacin Ophthalmic 0.3% Sol2.5 Ml[chas]","code_information":[{"code":"CP17640152376451595","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Dextrose 10% In Water 500 Ml [Chas]","code_information":[{"code":"CP17640152376462140","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338002303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Dextrose 5%/0.2% Sodium Chl 500 Ml Bag[chas]","code_information":[{"code":"CP17640152376462180","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338007704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Levetiracetam 500 Mg/100 Ml-ns 0.82% [Chas]","code_information":[{"code":"CP17640152376505733","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567050110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sodium Chloride 3% Intravenous Solution [Chas]","code_information":[{"code":"CP17640152376544379","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":48,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Hp D-dimer Pspc","code_information":[{"code":"35085379HP","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Stool Culture By Eia Pspc","code_information":[{"code":"35087045P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Stool Culture By Eia, Ad Pspc (Add-on)","code_information":[{"code":"35087046P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Bill Only Fed-ex","code_information":[{"code":"35099001-GY","type":"CDM"},{"code":"309","type":"RC"},{"code":"99001","type":"CPT","modifier":"GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GY"],"minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Rotavirus Ag Pspc","code_information":[{"code":"35087425P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Stool Culture Pspc","code_information":[{"code":"35087427P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Cautery, Hi-temp Vas Tip Disposable","code_information":[{"code":"1602015","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Snare Disposable 15mm","code_information":[{"code":"1600825","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600825","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"11001 Debride Infected Skin Add Onclinic","code_information":[{"code":"20011001","type":"CDM"},{"code":"521","type":"RC"},{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":47,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":28}]}]},{"description":"Influenza Abs Panel Pspc","code_information":[{"code":"35086710P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Russell Viper Venom Time Pspc","code_information":[{"code":"35085613P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Thrombin Time, Plasma Pspc","code_information":[{"code":"35085670P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Carbamazepine Pspc","code_information":[{"code":"35080156P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Venison Ige Pspc","code_information":[{"code":"35086003VNSN","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Fiberwire W/reverse","code_information":[{"code":"1601641","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601641","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"57160-insert Pessary/other Device-tech","code_information":[{"code":"14057160","type":"CDM"},{"code":"510","type":"RC"},{"code":"57160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"96370-sc Ther Infusion Addl Hr-tech","code_information":[{"code":"14596370","type":"CDM"},{"code":"260","type":"RC"},{"code":"96370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Catheter Thoracic 32fr","code_information":[{"code":"1601348","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601348","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"90473 Immunization Admin; Intranasal/oral;1 Vac [Chas]","code_information":[{"code":"20090473","type":"CDM"},{"code":"521","type":"RC"},{"code":"90473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"J0696 Ceftriaxone 1 Gm Vial [Chas]","code_information":[{"code":"200J06961","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Ampicill/sulbact 1.5 Gm Vial[chas]","code_information":[{"code":"CP17640152376444882","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049001383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Dexamethasone 10 Mg/ml1 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376468490","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Labetalol 5 Mg/ml4 Ml Ud Inj [Chas]","code_information":[{"code":"CP17640152376498413","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":46,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Azithromycin 500 Mg Vial[chas]","code_information":[{"code":"CP17640152376449353","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Enoxaparin 30 Mg/0.3 Ml Syringe[chas]","code_information":[{"code":"CP17640152376470777","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Immunoglobulins--a, M, & G Pspc","code_information":[{"code":"35082784QM","type":"CDM"},{"code":"302","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Alcohol, Serum Or Plasma Pspc","code_information":[{"code":"35080320PSP","type":"CDM"},{"code":"301","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Ankle Brace Aso Lg","code_information":[{"code":"1600040","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Ankle Brace Aso Med","code_information":[{"code":"1600041","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Ankle Brace Aso Sm","code_information":[{"code":"1600042","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Ankle Brace Aso Xlarge","code_information":[{"code":"1601496","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Catheter Thoracic 40fr","code_information":[{"code":"1601759","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601759","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Lithotomy Drape W/pouch","code_information":[{"code":"1600572","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600572","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Needle Stimuquik 21g 90mm","code_information":[{"code":"1601512","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601512","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Needle Stimuquik 22g 50mm","code_information":[{"code":"1601514","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601514","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Senser Sp02 Neonat/adult","code_information":[{"code":"1600808","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600808","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Transducer Cover 10.2x147","code_information":[{"code":"1601164","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601164","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}]},{"description":"Atropine 0.4 Mg/ml Vial[chas]","code_information":[{"code":"CP17640152376444631","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517040125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Esmolol Hcl 10mg/ml10 Ml Sdv[chas]","code_information":[{"code":"CP17640152376470116","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ampicillin 1 Gm Vial[chas]","code_information":[{"code":"CP17640152376441729","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781340495","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Oseltamivir  75 Mg Cap[chas]","code_information":[{"code":"CP17640152376527375","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":45,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":27}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pantoprazole 40 Mg Rec Inj [Chas]","code_information":[{"code":"CP17640152376535673","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Bone Marrow Needle Dispob","code_information":[{"code":"1600108","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Catheter Thoracic 24fr","code_information":[{"code":"1601351","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601351","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Cockup Splnt 8 Right Sm","code_information":[{"code":"1600258","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Needle/dis 25ga","code_information":[{"code":"1600655","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600655","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Nitro Set Vented","code_information":[{"code":"1601470","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601470","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Resuscitator Mask Child","code_information":[{"code":"1601287","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601287","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Resuscitator Mask Infant","code_information":[{"code":"1601286","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601286","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Scotchcast Splint3x 3.5","code_information":[{"code":"1600789","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600789","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Slimline Rhino Rocket Med","code_information":[{"code":"1600822","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600822","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup  6 Xxs Rt","code_information":[{"code":"1601462","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601462","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Lg 6 Lt","code_information":[{"code":"1601429","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601429","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Lg 6rt","code_information":[{"code":"1601428","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601428","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Lg 8 Lt","code_information":[{"code":"1601443","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601443","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Lg 8 Rt","code_information":[{"code":"1601441","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Med 6 Lt","code_information":[{"code":"1601424","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601424","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Med 8 Rt","code_information":[{"code":"1601442","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601442","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Sm 6 Lt","code_information":[{"code":"1601413","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601413","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Sm 6 Rt","code_information":[{"code":"1601412","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601412","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Sm 8 Lt","code_information":[{"code":"1601435","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601435","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xlg 6 Lt","code_information":[{"code":"1601432","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601432","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xlg 6rt","code_information":[{"code":"1601426","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601426","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xlg 8 Lt","code_information":[{"code":"1601461","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601461","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xlg 8 Rt","code_information":[{"code":"1601460","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601460","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xs 6 Rt","code_information":[{"code":"1601420","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xs 6lt","code_information":[{"code":"1601419","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601419","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xs 8 Rt","code_information":[{"code":"1601422","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601422","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Scotchcast 4 X30","code_information":[{"code":"1600849","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600849","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Suture:ethilon 4-0 #699g","code_information":[{"code":"1600994","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Trigger & Keepers Thumb L","code_information":[{"code":"1601508","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601508","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Trigger & Keepers Thumb M","code_information":[{"code":"1601507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Umbilical Cath 3.5 Fr","code_information":[{"code":"1601184","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601184","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"90471 Immunization Administration; 1 Vaccine","code_information":[{"code":"20090471","type":"CDM"},{"code":"521","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Aminophylline 25mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376444856","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Glycopyrrolate  0.2 Mg/ml Syringe[chas]","code_information":[{"code":"CP17640152376488880","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121169807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ropivacaine 0.5%  Inj [Chas]","code_information":[{"code":"CP17640152376548132","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sufentanil 50 Mcg/ml Sol [Chas]","code_information":[{"code":"CP17640152376551902","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409338221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Lidocaine/d5w 500ml4mg/ml Bag[chas]","code_information":[{"code":"CP17640152376506616","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338040903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":44,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Flumazenil 0.1 Mg/ml5 Ml Mdv1 Ml [Chas]","code_information":[{"code":"CP17640152376482072","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Rocuronium 10 Mg/ml5 Ml  Mdv1 Ml [Chas]","code_information":[{"code":"CP17640152376543537","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fruit Panel Igg (Ibt) Pspc","code_information":[{"code":"35086001FP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Bowcdh Decalcification","code_information":[{"code":"350DCAL","type":"CDM"},{"code":"311","type":"RC"},{"code":"88311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Body Fluid Crystals Pspc","code_information":[{"code":"35089060P","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Celiac Disease Reflexive Cascade (Arup) Pspc","code_information":[{"code":"35082784ARUP","type":"CDM"},{"code":"302","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Non-routine Bl Draw 3/>yrs","code_information":[{"code":"14536410","type":"CDM"},{"code":"761","type":"RC"},{"code":"36410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"2 Layer Compression System","code_information":[{"code":"1602090","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602090","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Cath Irr Latex 30cc 20fr","code_information":[{"code":"1600175","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600175","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Catheter Thoracic 28fr","code_information":[{"code":"1601350","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601350","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Dressing Bike Pressure Small","code_information":[{"code":"1601630","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601630","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Dressing Ribbon Ag Advant Silver .78x18","code_information":[{"code":"1601978","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Needle Spinal 22 X 2.50","code_information":[{"code":"1601521","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601521","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xxsm 6lt","code_information":[{"code":"1601423","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601423","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xxxsm 4.5lt","code_information":[{"code":"1601425","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601425","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Splint Cockup Xxxsm 4.5rt","code_information":[{"code":"1601433","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601433","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Thumb Splint Universal","code_information":[{"code":"1601148","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601148","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Trigger & Keepers Thumb S","code_information":[{"code":"1601506","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601506","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"90480 Immunization Admin Im; Covid Vaccine [Chas]","code_information":[{"code":"20090480","type":"CDM"},{"code":"521","type":"RC"},{"code":"90480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Injection, Adrenalin, Epinephrine, 0.1 Mg Chas Clinic","code_information":[{"code":"200J0171","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Injection, Ceftriaxone Sodium, Per 250 Mg","code_information":[{"code":"200J0696-CG","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0696","type":"HCPCS","modifier":"CG"}],"standard_charges":[{"setting":"outpatient","modifier_code":["CG"],"minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}]},{"description":"Bupivacaine Hcl 0.25% 10 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376458994","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Levofloxacin/d5w 750 Mg/150 Ml Bag[chas]","code_information":[{"code":"CP17640152376506210","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":43,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":26}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sickle Cell Solubility Test (Rps) Pspc","code_information":[{"code":"35085660P","type":"CDM"},{"code":"305","type":"RC"},{"code":"85660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Blade Long Narrow 25.0mm X 5.5mm","code_information":[{"code":"1601874","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601874","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Bur Round Diamond 4.5mm","code_information":[{"code":"1601871","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601871","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Cath. Subclavian Jugl.14f","code_information":[{"code":"1601269","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601269","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Catheter Thoracic 20fr","code_information":[{"code":"1601349","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601349","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Clavicle Strap Padded Med","code_information":[{"code":"1600231","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600231","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Clavicle Strap Padded Sm","code_information":[{"code":"1600232","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600232","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Cockup Splint 8 Left Med","code_information":[{"code":"1600247","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600247","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Cockup Splint 8 Left Xsm","code_information":[{"code":"1600249","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600249","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Drain Round 10fr W/trocar","code_information":[{"code":"1600321","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Duoderm Cgf Border 6x7","code_information":[{"code":"1600334","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600334","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Suture Pds Ii Violet 96 Tp-1","code_information":[{"code":"1601863","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601863","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Trap Suction Polyp","code_information":[{"code":"1601165","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601165","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Flu Vaccine Live Intranasal Poc","code_information":[{"code":"20090660","type":"CDM"},{"code":"521","type":"RC"},{"code":"90660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Benzocaine/butamben/tetracaine Topical Spray [Chas]","code_information":[{"code":"CP17640152376444485","type":"CDM"},{"code":"250","type":"RC"},{"code":"10223020104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2% Preservative-free Sol  [Chas]","code_information":[{"code":"CP17640152376507906","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":42,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hydrocortisone 25 Mg Supp[chas]","code_information":[{"code":"CP17640152376482059","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574709012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylprednisolone Sod Suc 40 Mg Vial[chas]","code_information":[{"code":"CP17640152376515952","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Smear, Afb Pspc Add On Charge","code_information":[{"code":"35087206P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Ana Igg By Elisa W/reflex To Hep2 Substrate Pspc","code_information":[{"code":"35086038PS","type":"CDM"},{"code":"302","type":"RC"},{"code":"86038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"20605-drain/inject Joint/bursa -Sc Tech","code_information":[{"code":"14020605","type":"CDM"},{"code":"510","type":"RC"},{"code":"20605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Co2 Detector Adult","code_information":[{"code":"1600234","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600234","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Co2 Detector Pedicap","code_information":[{"code":"1601401","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601401","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}]},{"description":"Propofol 10 Mg/ml20 Ml Sdpf Chas]","code_information":[{"code":"CP17640152376548362","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem 5 Mg/ml25 Ml Sdv[chas]","code_information":[{"code":"CP17640152376471286","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lidocaine  20 Mg/ml5 Ml Syringe[chas]","code_information":[{"code":"CP17640152376501628","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":41,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":25}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Q3014-telehealth Originating Site -Ed Tech","code_information":[{"code":"135Q3014","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Iga Rps","code_information":[{"code":"35086364TTG","type":"CDM"},{"code":"302","type":"RC"},{"code":"86364","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Ttg Iga Rps","code_information":[{"code":"35082784RPS","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Drain Kit Flat 10mm W/100cc Reservoir","code_information":[{"code":"1601637","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601637","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Biliblanket/vest (5)","code_information":[{"code":"1600077","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Catheter Fo 26fr30cc 3-wa","code_information":[{"code":"1601296","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601296","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Dressing Silver  Promogran Prisma 4 1/3 X 4 1/3","code_information":[{"code":"1602052","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Laryngoscope Handlew/ Miiler Blade, Size 2, Disposable","code_information":[{"code":"1602026","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Meconium Suction 3.0mm","code_information":[{"code":"1601327","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601327","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Meconium Suction 3.5mm","code_information":[{"code":"1601328","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601328","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Shoulder Immobilizer Univ","code_information":[{"code":"1601465","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601465","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Suture Monocryl Violet 0 Ct-1 Cr/4","code_information":[{"code":"1601395","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601395","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Universal Arm Immobil Xlg","code_information":[{"code":"1601192","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601192","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}]},{"description":"Solifenacin 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376559828","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505470203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Digoxin 0.25 Mg/ml2 Ml Amp[chas]","code_information":[{"code":"CP17640152376472665","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":40,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":24}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"24 Hr Urine Collection Charge","code_information":[{"code":"35081050P","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"86671","code_information":[{"code":"35086671P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Body Fluid Lipase Pspc","code_information":[{"code":"35083690P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Rubeola Ab Pspc","code_information":[{"code":"35086765P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Syphilis Serology Pspc","code_information":[{"code":"35086780P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"20550-inj Tendon Sheath/ligament- Sc Tech","code_information":[{"code":"14020550","type":"CDM"},{"code":"510","type":"RC"},{"code":"20550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"20551 Inj Tendon Single Clinic Chargegood","code_information":[{"code":"14020551","type":"CDM"},{"code":"510","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"20600-drain/inject Joint/bursa -Sc Tech","code_information":[{"code":"14020600","type":"CDM"},{"code":"510","type":"RC"},{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Cockup Splint 6 Right Me","code_information":[{"code":"1600242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"D-type Anat Slimline Nasa","code_information":[{"code":"1600333","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600333","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Ioban 2 Antimicrobial Incise Drape","code_information":[{"code":"1602127","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602127","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"11201 Removal Of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Each Addtl Ten Lesions Charge","code_information":[{"code":"20011201","type":"CDM"},{"code":"521","type":"RC"},{"code":"11201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Cyanocobalamine 1000 Mcg/ml Sdv[chas]","code_information":[{"code":"CP17640152376463290","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680011210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Ketorolac  30 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376492329","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ropivacaine 0.2% 1 Mg / 0.5 Ml10 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376542864","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069006125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Clotrimazole/betamethasone 1-0.05% 15 Gm Cream[chas]","code_information":[{"code":"CP17640152376461134","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":39,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Insurance/lab One Draw","code_information":[{"code":"35036415","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Magnesium, Urine Random Pspc","code_information":[{"code":"35083735P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"20526- Ther Injection Carp Tunnel -Sc Tech","code_information":[{"code":"14020526","type":"CDM"},{"code":"510","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Abdominal Binder 26-50","code_information":[{"code":"1600012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Cath 3-way 18 Fr 5 Cc","code_information":[{"code":"1600164","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600164","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Dressing Aquacel Ag 4x5 W/silver","code_information":[{"code":"1601995","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601995","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Leg Lifter Rigid","code_information":[{"code":"1601792","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601792","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Nipple Shield 24mm Medium","code_information":[{"code":"1601746","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601746","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Post-op Shoe Mens X-large","code_information":[{"code":"1601455","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601455","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Sensor Pediaric Spo2","code_information":[{"code":"1601527","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601527","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Sensor Spo2 Pedi","code_information":[{"code":"1600810","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Suture With Needle Monocryl Y936h","code_information":[{"code":"1602124","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602124","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"90472  Each Additional Vaccine","code_information":[{"code":"20090472","type":"CDM"},{"code":"521","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"G0444 Screening For Depression","code_information":[{"code":"200G0444","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Hepatitis B Admin [Chas]","code_information":[{"code":"200HEPB","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Influenza Admin [Chas]","code_information":[{"code":"200FLU","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Pneumococcal 20 Admin [Chas]","code_information":[{"code":"200PNEUMO","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Influenza Vaccine (G0008)","code_information":[{"code":"200G0008","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}]},{"description":"Enalaprilat 1.25 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376471929","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":38,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":23}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Bupivacaine-epinephrine 0.25% 10 Ml Sdpf [Chas]","code_information":[{"code":"CP17640152376457144","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"83527 Insulin, Total (Arup) Pspc","code_information":[{"code":"35083527P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Hepatitis B Surface Antibody, Pspc","code_information":[{"code":"35086706P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"96373â Â Therapeutic Prophylactic/dx Njx Intra-arterial Techfee","code_information":[{"code":"13596373","type":"CDM"},{"code":"450","type":"RC"},{"code":"96373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Osmolality, Serum Pspc","code_information":[{"code":"35083930P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Catheter Angiocath 14g X 1.8 In","code_information":[{"code":"1602080","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Ketorolac  15 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376497028","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levalbuterol 1.25 Mg/0.5 Ml Svn[chas]","code_information":[{"code":"CP17640152376490839","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378699393","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Lidocaine Hcl 0.5%50 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376501921","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":37,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Catheter Angiocath 24ga X .75in","code_information":[{"code":"1601960","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601960","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Catheter Coude 22fr 5cc","code_information":[{"code":"1601267","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601267","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Suture Flexan 3-0 Cv-23","code_information":[{"code":"1600933","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600933","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}]},{"description":"Erythromycin Ophthalmic 0.5% Oin[chas]","code_information":[{"code":"CP17640152376473156","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Nalbuphine 10 Mg/ml  Amp[chas]","code_information":[{"code":"CP17640152376511836","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxytocin 10 Units/ml Sdv[chas]","code_information":[{"code":"CP17640152376538390","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":10,"type":"UN"}},{"description":"Prochlorperazine 25 Mg Supp[chas]","code_information":[{"code":"CP17640152376535114","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bumetanide 1 Mg/4 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376446995","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219057004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":36,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":22}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Potassium Chloride 10 Meq/100 Ml Iv Sol[chas]","code_information":[{"code":"CP17640152376531567","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Capillary Draw","code_information":[{"code":"35036416","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Folate Pspc","code_information":[{"code":"35082746P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Hbsag, Pspc","code_information":[{"code":"35087340P","type":"CDM"},{"code":"302","type":"RC"},{"code":"87340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Blood test, lipids","code_information":[{"code":"35080061P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Osmolality, Urine To Gph Pspc","code_information":[{"code":"35083935P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"T3 Total Pspc","code_information":[{"code":"35084480P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Vag Patho D Probe Pspc","code_information":[{"code":"35087660P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Vit B12 & Folate Pspc","code_information":[{"code":"35082607P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"69210-remove Impacted Ear Wax Uni-sc Tech","code_information":[{"code":"14069210","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Application Of Finger Splint Static","code_information":[{"code":"14029130","type":"CDM"},{"code":"510","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Chas Iv Contrast 1 Ml","code_information":[{"code":"360Q9967","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Bilirubin Blanket","code_information":[{"code":"1600080","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Cautery Wand Mini","code_information":[{"code":"1601427","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601427","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Compression Stocking Calf","code_information":[{"code":"1600274","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Ellik Evacuator","code_information":[{"code":"1600357","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600357","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Post Op Shoe Ladies Lg","code_information":[{"code":"1600734","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600734","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Post Op Shoe Mens Sm","code_information":[{"code":"1600739","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Sorbital Irrig 3000cc","code_information":[{"code":"1600834","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Splint Nasal Small","code_information":[{"code":"1601532","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601532","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Uretheral Cath Whstl 6fr","code_information":[{"code":"1601202","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601202","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"90648 Hiberixhaemophilus Infl Type B (Hib) 4 Dose [Chas]","code_information":[{"code":"20090648","type":"CDM"},{"code":"521","type":"RC"},{"code":"90648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Kenalog 40mg Im/iv","code_information":[{"code":"200J330140","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Phenylephrine 10 Mg/ml1 Ml [Chas]","code_information":[{"code":"CP17640152376532168","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781342292","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem 5 Mg/ml5 Ml Sdv[chas]","code_information":[{"code":"CP17640152376471157","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydromorphone 0.5 Mg/0.5 Ml Inj [Chas]","code_information":[{"code":"CP17640152376484319","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":35,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Uric Acid Value, 24 Hr Ur Pspc","code_information":[{"code":"35084560P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Repair Of Nonunion Or Malunion Of Humerus; Withi Liliac Or Other Autograft","code_information":[{"code":"14011105","type":"CDM"},{"code":"510","type":"RC"},{"code":"11105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"C-collar Foam Lg Narrow","code_information":[{"code":"1601464","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601464","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Cath Foley Lf Ic 16fr 5cc","code_information":[{"code":"1600616","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Cath Foley Lf Ic 18fr 5cc","code_information":[{"code":"1601559","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601559","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Catheter Foley 20fr 5cc","code_information":[{"code":"1601292","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601292","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Dressing Acticoat 3/4x12","code_information":[{"code":"1600323","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600323","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Venturi Suction Canister","code_information":[{"code":"1601477","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601477","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":34,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":21}]}]},{"description":"Morphine 2 Mg/ml Pf Syringe [Chas]","code_information":[{"code":"CP17640152376516025","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nicotine & Metabolites, Serum Pspc","code_information":[{"code":"35080323P","type":"CDM"},{"code":"300","type":"RC"},{"code":"80323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Ua Micro 13","code_information":[{"code":"35081015","type":"CDM"},{"code":"307","type":"RC"},{"code":"81015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Cervical Collar Med","code_information":[{"code":"1600207","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600207","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Heel Wedge 4 Degrees","code_information":[{"code":"1600471","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600471","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Ltx Foley Cath 30cc 18fr","code_information":[{"code":"1600579","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Nasal Atomizatin Device","code_information":[{"code":"1600628","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600628","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Suction Frazier 5fr","code_information":[{"code":"1601537","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601537","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Suture Chromic 6-0","code_information":[{"code":"1600928","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600928","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Suture Plain Gut 4-0","code_information":[{"code":"1601529","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601529","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Tur Y Set","code_information":[{"code":"1601179","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601179","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}]},{"description":"Nystatin Topical 100000 Units/g Oint [Chas]","code_information":[{"code":"CP17640152376528541","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004835","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Lidocaine 2% Pf Iv20mg/ml [Chas]","code_information":[{"code":"CP17640152376509461","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Metronidazole/sod Chl 500 Mg/100 Ml Bag[chas]","code_information":[{"code":"CP17640152376514547","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Polymyxin B-trimethoprim Opth Sol10 Ml[chas]","code_information":[{"code":"CP17640152376533974","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Budesonide 0.5 Mg/2 Ml Svn [Chas]","code_information":[{"code":"CP17640152376448169","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dexamethasone 4 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376469475","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":33,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":20}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Diphenhydramine 50 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376472856","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045010210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"87491","code_information":[{"code":"35087491P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Antigliadin Ab Igg (Rps) Pspc","code_information":[{"code":"35086258P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Crcl Pspc","code_information":[{"code":"35082575P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Ssb Antibody (Rps) Pspc","code_information":[{"code":"35086235PB","type":"CDM"},{"code":"302","type":"RC"},{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"23593-1232-42gi Cocktail[chas]","code_information":[{"code":"1651696-GY","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS","modifier":"GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GY"],"minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"11042- Deb Subq Tissue 20 Sq Cm/<sc Tech","code_information":[{"code":"14011042","type":"CDM"},{"code":"510","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Tangential Biopsy Of Skin; Each Additional Lesion","code_information":[{"code":"14011103","type":"CDM"},{"code":"510","type":"RC"},{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"3-0 Coated Vicryl 27 J219h","code_information":[{"code":"1602106","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Buretrol Iv Tubing","code_information":[{"code":"1600126","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"C Collar Stiffneck Infant","code_information":[{"code":"1600132","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600132","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Cervical Collar Adjust","code_information":[{"code":"1600205","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600205","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Dressing Sacrum Small 17.2 X 17.5","code_information":[{"code":"1601826","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601826","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Luki Tube","code_information":[{"code":"1600592","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600592","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Metatarsal Bars","code_information":[{"code":"1600614","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600614","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Neuro Sponges 1/2 X 3","code_information":[{"code":"1601530","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601530","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Suture:chromic 4-0 #1654g","code_information":[{"code":"1600971","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600971","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Clindamycin 150 Mg/ml2 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376466576","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupivacaine/epineph 0.5% 30 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376456354","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409904517","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Sodium Polystyrene Sulfonate 15 G/60 Ml Oral Susp[chas]","code_information":[{"code":"CP17640152376559913","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Furosemide 10 Mg/ml2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376485530","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":32,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"86003-allergen Specific Ige, Quant Pspc","code_information":[{"code":"35086003","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Bill Beta Lactamase Sensitivity, Pspc","code_information":[{"code":"35087185P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Coombs, Test Direct Pspc","code_information":[{"code":"35086880P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Egg Whole, Ige (Ibt) Pspc","code_information":[{"code":"35086003IBT","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Tissue Process, Gross Pspc","code_information":[{"code":"35088300P","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"29580-strapping; Unna Boot-sc Tech","code_information":[{"code":"14029580","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Cath Foley Ic 14fr 5cc","code_information":[{"code":"1601623","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601623","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Cath Foley Ic 16fr 5cc","code_information":[{"code":"1601624","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601624","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Cath Foley Ic 18fr 5cc","code_information":[{"code":"1601625","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601625","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Drain Flat 10mm W/trocar","code_information":[{"code":"1601546","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601546","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Incentive Spirometer Pedi","code_information":[{"code":"1601290","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601290","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Needle Huber 20ga 90mm","code_information":[{"code":"1600645","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600645","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Resuscitation Bag Adult","code_information":[{"code":"1600765","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600765","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Splint Cockup 8 Univ Lt","code_information":[{"code":"1601556","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601556","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Splint Cockup 8 Univ Rt","code_information":[{"code":"1601555","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601555","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Tray Gastric Lavage Large 34 Fr","code_information":[{"code":"1601302","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601302","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Flu Vaccine Split 3 Yrs And Above Im Poc","code_information":[{"code":"20090658","type":"CDM"},{"code":"521","type":"RC"},{"code":"90658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Inj Fluzone Intradermal","code_information":[{"code":"20090654","type":"CDM"},{"code":"521","type":"RC"},{"code":"90654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Trimming Of Nondystrophic Nails, Any Number Charge","code_information":[{"code":"20011719","type":"CDM"},{"code":"521","type":"RC"},{"code":"11719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}]},{"description":"Fentanyl 50 Mcg/ml1 Ml [Chas]","code_information":[{"code":"CP17640152376477546","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323080811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Metoclopramide 10 Mg/2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376516746","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bupivacaine Hcl  0.5% 10 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376452760","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cefazolin 1 Gm Vial[chas]","code_information":[{"code":"CP17640152376459006","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":31,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":19}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"83516","code_information":[{"code":"35083516SC","type":"CDM"},{"code":"302","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Carbon Dioxide Level","code_information":[{"code":"35082374","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Koh Prep Skin, Hair Nails","code_information":[{"code":"35087220P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Cervical Collar Stifneck","code_information":[{"code":"1600215","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600215","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Mat Absorbent 28 X 40","code_information":[{"code":"1601710","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601710","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Needle Electrode Extended 4","code_information":[{"code":"1602060","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Shoulder Immob X-small","code_information":[{"code":"1601567","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601567","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Shoulder Pulley","code_information":[{"code":"1601586","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601586","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Vent Tube","code_information":[{"code":"1601227","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Tb Skin Test Poc","code_information":[{"code":"20086580","type":"CDM"},{"code":"521","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Bupivacaine Hcl 0.25%30 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376458395","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Apixaban 5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376444734","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Heparin Sodium 5,000 Units/ml Sdv [Chas]","code_information":[{"code":"CP17640152376481772","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Promethazine 25 Mg/ml Inj Sol[chas]","code_information":[{"code":"CP17640152376537056","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bupivacaine Hcl 0.5% 30 Ml Sdpf[chas]","code_information":[{"code":"CP17640152376451176","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":30,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Magnesium Sulfate 50%  1 Gm/2 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376506660","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":50,"type":"GR"}},{"description":"64421-inj Anes Ag/steroid, Intercostal Nerve, Each Add-surg Tech","code_information":[{"code":"12564421","type":"CDM"},{"code":"360","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"C-collar Foam Med Narrow","code_information":[{"code":"1601417","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601417","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"C-collar Foam Pediatric","code_information":[{"code":"1601344","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601344","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Catheter Foley 18fr 5cc","code_information":[{"code":"1601289","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601289","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Elastoplast Bandage  4","code_information":[{"code":"1600345","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600345","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Sodium Chl 0.9% Irr 3000ml Uromatic","code_information":[{"code":"1601957","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601957","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Surgifoam S2 12-7","code_information":[{"code":"1601613","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601613","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Suture Polysorsb 3-0 Ct-1, Cl842","code_information":[{"code":"1601737","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601737","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Injection, Triamcinolone Acetonide, Per 10mg Charge","code_information":[{"code":"200J3301","type":"CDM"},{"code":"521","type":"RC"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"95117 Allergy Injection Multi Poc","code_information":[{"code":"20095117","type":"CDM"},{"code":"521","type":"RC"},{"code":"95117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"92567 Tympanometry-clinic","code_information":[{"code":"20092567","type":"CDM"},{"code":"521","type":"RC"},{"code":"92567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}]},{"description":"Amiodarone 150mg/3ml Sdv[chas]","code_information":[{"code":"CP17640152376444675","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Gentamicin 40 Mg/ml2 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376485448","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Hydromorphone  2 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376487098","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409336501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":18}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Allergen Specific Ige, Qualitative","code_information":[{"code":"35086005P","type":"CDM"},{"code":"300","type":"RC"},{"code":"86005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Culture Aerobic, Wound Pspc","code_information":[{"code":"35087070WP","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Gram Stain, Wound Pspc","code_information":[{"code":"35087205WP","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Protine, Urine [Monoclonal] [Chas] Pspc","code_information":[{"code":"35084156MP","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Genital Culture Pspc","code_information":[{"code":"35087070G","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Hgb A1c, Pspc","code_information":[{"code":"35083036P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Capnography Filter Mois T","code_information":[{"code":"1601562","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601562","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Cautery Pen Disposable","code_information":[{"code":"1600197","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600197","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Suture Chro Gut 5-0 C1","code_information":[{"code":"1600927","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Suture Monocryl 3-0 Ps-2 Y427h","code_information":[{"code":"1602057","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Thermometer Hypothermia","code_information":[{"code":"1601297","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601297","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Tray Lumbar Adult","code_information":[{"code":"1601303","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601303","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Inj Enoxaparin Sodium","code_information":[{"code":"200J1650","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Lorazepam 2 Mg/ml1 Ml Sdv[chas]","code_information":[{"code":"CP17640152376507415","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Silver Sulfadiazine Topical 1%50 Gm Cre[chas]","code_information":[{"code":"CP17640152376547076","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":29,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Haloperidol 5 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376489156","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aminophylline 100 Mg Charge","code_information":[{"code":"1651021","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"20611-drain/inj Joint/bursa W/us -Sc Tech","code_information":[{"code":"14020611","type":"CDM"},{"code":"510","type":"RC"},{"code":"20611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"64455 Injection Plantar Common Digital Nerve","code_information":[{"code":"14064455","type":"CDM"},{"code":"510","type":"RC"},{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Dressing Optifoam Gentle Nb Ag 4x4","code_information":[{"code":"1602019","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Endometrial Pipelle","code_information":[{"code":"1601618","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601618","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Imm0bilizer Head Multi-grip Adult","code_information":[{"code":"1601782","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601782","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Knee Support X-large","code_information":[{"code":"1601372","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601372","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Ostomy Skin Barrier, New Image, Convex 1 1/2 14803","code_information":[{"code":"1602035","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Sod Chl Irr 0.9% 3000ml","code_information":[{"code":"1600827","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Suction Frazier 8fr Disp","code_information":[{"code":"1600905","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600905","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Thigh Sleeve Xlg","code_information":[{"code":"1601631","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601631","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"90630 Quadrivalent Intradermal 18 To 64 Years","code_information":[{"code":"20090630","type":"CDM"},{"code":"521","type":"RC"},{"code":"90630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"J1010 Methylprednisolone Acetate 40 Mg [Chas]","code_information":[{"code":"200J1030","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}]},{"description":"Metoprolol 5 Mg/5 Ml Sdv[chas]","code_information":[{"code":"CP17640152376511179","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409177805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midazolam 5 Mg/ 5ml Preservative-free Sol [Chas]","code_information":[{"code":"CP17640152376511813","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409230505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Morphine 4 Mg/ml Pres.free[chas]","code_information":[{"code":"CP17640152376519991","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Morphine Sulfate 10 Mg/ml Sdv[chas]","code_information":[{"code":"CP17640152376514633","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641607025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tolterodine 4 Mg Ercap[chas]","code_information":[{"code":"CP17640152376559488","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436016104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fentanyl 0.05 Mg/ml2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376479500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam 2 Mg/ml1 Ml Mdv [Chas]","code_information":[{"code":"CP17640152376505296","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":28,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Famotidine 10 Mg/ml2 Ml Sdv [Chas]","code_information":[{"code":"CP17640152376477464","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Neostigmine 1 Mg/ml [Chas]","code_information":[{"code":"CP17640152376528656","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"C-collar Foam Large Reg","code_information":[{"code":"1601463","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601463","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Catheter Thoracic 16fr","code_information":[{"code":"1601486","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601486","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Dressing Bike Pressure Xlg","code_information":[{"code":"1601620","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601620","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Dressing Maxorb Extra Ag Algnte","code_information":[{"code":"1601588","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601588","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Foley Tray","code_information":[{"code":"1600425","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600425","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Infustion Set","code_information":[{"code":"1600503","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"K-wire 6","code_information":[{"code":"1601388","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601388","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Needle Spinal Whitacre 25x5","code_information":[{"code":"1601581","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601581","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Paclitxel Iv Tubing","code_information":[{"code":"1600689","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600689","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Suture Monocryl 4-0 Mcp935h","code_information":[{"code":"1600937","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Influenza Virus Vaccine, Quadrivalent (Iiv4), Split Virus, 0.5 Ml Dosage, For Im Use","code_information":[{"code":"20090688","type":"CDM"},{"code":"521","type":"RC"},{"code":"90688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}]},{"description":"Albuterol 0.083%2.5 Mg/3 Ml Svn[chas]","code_information":[{"code":"CP17640152376435166","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":83,"type":"ME"}},{"description":"Albuterol/ipratropium 2.5 Mg-0.5 Mg/3ml Svn[chas]","code_information":[{"code":"CP17640152376435210","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levalbuterol  0.63 Mg/3 Ml Svn[chas]","code_information":[{"code":"CP17640152376498633","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":63,"type":"ME"}},{"description":"Racepinephrine 2.25%0.5 Ml Sol Ud[chas]","code_information":[{"code":"CP17640152376548240","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":225,"type":"ML"}},{"description":"Ketamine 50 Mg/ml10 Ml Mdv1 Ml[chas]","code_information":[{"code":"CP17640152376491114","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150043910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":27,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":16}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Midazolam Hcl 1 Mg/ml2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376518929","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Heparin Quant Assay Pspc","code_information":[{"code":"35085520LAP","type":"CDM"},{"code":"305","type":"RC"},{"code":"85520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"La Screen Drvvt Pspc","code_information":[{"code":"35085613LAP","type":"CDM"},{"code":"305","type":"RC"},{"code":"85613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"35085730LAP","type":"CDM"},{"code":"301","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"35085610LAP","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Sensitivity, Bacteria Pspc","code_information":[{"code":"35087186P","type":"CDM"},{"code":"306","type":"RC"},{"code":"87186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Thrombin Time Pspc","code_information":[{"code":"35085670LAP","type":"CDM"},{"code":"305","type":"RC"},{"code":"85670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"51701 Straight Cath Placement","code_information":[{"code":"14051701","type":"CDM"},{"code":"510","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Apply Multilay Comprs Lwr Leg","code_information":[{"code":"14029581","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Oxygen Therapy Per Hr","code_information":[{"code":"300001","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP300001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Aerochamber","code_information":[{"code":"1600021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Bandage Elastoplast 2","code_information":[{"code":"1601300","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Drainage Pouch With Filter 2 1/4","code_information":[{"code":"1601881","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601881","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Dressing Bike Pressure Med","code_information":[{"code":"1601595","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601595","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Et Introducer 15fr Coude","code_information":[{"code":"1600381","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600381","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Ioban Steri-drape","code_information":[{"code":"1600518","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600518","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Needle Electrode 2.75 In","code_information":[{"code":"1600643","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600643","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Needle Spinal Pp 25gx5","code_information":[{"code":"1601569","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601569","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Needle Stimquik 21g 150mm","code_information":[{"code":"1601513","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Neo Mask 60mm","code_information":[{"code":"1600656","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600656","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Polywic Cavity Wound Filler 3inx 3in","code_information":[{"code":"1601869","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601869","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Pouch Drainage, Transp W/filter","code_information":[{"code":"1601843","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Pouch, Urostomy New Image #18403","code_information":[{"code":"1602036","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1602036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Suture Prolene 2-0 Sh 8833h","code_information":[{"code":"1601860","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601860","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Suture Prolene 3-0 Pc-5","code_information":[{"code":"1601409","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601409","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Suture Silk 3-0 Black 12 X 30 Strands","code_information":[{"code":"1601862","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601862","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Water Sterile Irr 3000ml","code_information":[{"code":"1601839","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601839","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Wax Bone 2.5 Grams","code_information":[{"code":"1601833","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Ondansetron  2 Mg/ml2 Ml Sdv[chas]","code_information":[{"code":"CP17640152376528158","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":26,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Labetalol  5 Mg/ml Mdv1 Ml [Chas]","code_information":[{"code":"CP17640152376494996","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Crp Pspc","code_information":[{"code":"35086140P","type":"CDM"},{"code":"301","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"11104 Punch Biopsy Skin Includes  Simple Closure Single Lesion","code_information":[{"code":"14011104","type":"CDM"},{"code":"761","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"4-0 Coated Vicryl 18 J496","code_information":[{"code":"1602105","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602105","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Eakin Cohesive Slims","code_information":[{"code":"1601538","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601538","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Knee Support Small","code_information":[{"code":"1601369","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601369","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Resus Kit W/o Mask","code_information":[{"code":"1600764","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600764","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Splint Oval-8 Finger","code_information":[{"code":"1601533","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601533","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Suture 4-0 Monocryl Ps-2 Mcp426h","code_information":[{"code":"1601990","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Rapid Strep Poc","code_information":[{"code":"20087880","type":"CDM"},{"code":"521","type":"RC"},{"code":"87880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}]},{"description":"Insulin Glargine 1 Unitof 10 Ml Vial[chas]","code_information":[{"code":"CP17640152376491725","type":"CDM"},{"code":"250","type":"RC"},{"code":"00088222033","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Lispro 100 Units/ml3 Ml Vial1 Unit[chas]","code_information":[{"code":"CP17640152376496846","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Insulin Regular 100u/ml1 Unit[chas]","code_information":[{"code":"CP17640152376492861","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002021301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Norepinephrine 4 Mg/250 Ml-nacl 0.9% Sol [Chas]","code_information":[{"code":"CP17640152376522863","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567064010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":25,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":15}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Capnography Conn W/10ft Line+m Filter","code_information":[{"code":"1600281","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Dressing Therabond 3d 4.25 X 4.25","code_information":[{"code":"1601684","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601684","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Q3014-telehealth Originating Site -Client","code_information":[{"code":"900Q3014","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Conversion Balance Adj","code_information":[{"code":"CP17640151597117731","type":"CDM"},{"code":"CP17640151597117731","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Hi-flow Humidifier","code_information":[{"code":"1600482","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600482","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Limb Sheets","code_information":[{"code":"1600569","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600569","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Lumbar Tray  Pediatric","code_information":[{"code":"1600594","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600594","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Nasopharyngeal Airway 32f","code_information":[{"code":"1600637","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600637","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Needle Spinal Pecan25x3.5","code_information":[{"code":"1601549","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601549","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Needle Touhy Epi 17gx4.5","code_information":[{"code":"1601568","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601568","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Opsite Post-op Visible 8 (Dressing)","code_information":[{"code":"1601765","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601765","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Post-op Shoe Mens Large","code_information":[{"code":"1601453","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601453","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Reacher, Standard 26","code_information":[{"code":"1601793","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601793","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Splint Colles Wrist Lg Rt","code_information":[{"code":"1601444","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601444","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture Pds Plus","code_information":[{"code":"1600943","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture Prolene 6-0 P3","code_information":[{"code":"1601396","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601396","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:prolene 5-0 #86908","code_information":[{"code":"1601041","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Umbiliclip","code_information":[{"code":"1601187","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601187","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Water Sterile For Inhalation 1000ml","code_information":[{"code":"1602135","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"J0702 Injection, Betamethasone Acetate 3 Mg And Betamethasone Sodium Phosphate 3 Mg","code_information":[{"code":"200J0702","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"95115 Allergy Injection Single Poc","code_information":[{"code":"20095115","type":"CDM"},{"code":"521","type":"RC"},{"code":"95115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Charcoal 25 Gm Susp [Chas]","code_information":[{"code":"CP17640152376456618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574052174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Tetracaine Ophthalmic 0.5% Sol  [Chas]","code_information":[{"code":"CP17640152376553161","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":24,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"82340- Supersaturation Profile--calcium","code_information":[{"code":"35082340P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"82436- Supersaturation Profile--chloride","code_information":[{"code":"35082436P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"84133- Supersaturation Profile--potassium","code_information":[{"code":"35084133P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"84392- Supersaturation Profile--sulfate","code_information":[{"code":"35084392P","type":"CDM"},{"code":"301","type":"RC"},{"code":"84392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"76329-3013-05lidocaine Topical 2% Gel10 Ml Syringe [Chas]","code_information":[{"code":"1651295-GY","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS","modifier":"GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GY"],"minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"11057 Paring/cutting Les >4","code_information":[{"code":"14011057","type":"CDM"},{"code":"510","type":"RC"},{"code":"11057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"30903control Of Nosebleedsc Tech","code_information":[{"code":"14030903","type":"CDM"},{"code":"510","type":"RC"},{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Remove Skin Tag Each Add'l 10 Skin Tags Charge","code_information":[{"code":"14011201","type":"CDM"},{"code":"510","type":"RC"},{"code":"11201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Cautery Tip Blade 1 Ultr","code_information":[{"code":"1601525","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Clavicle Brace Infant Pad","code_information":[{"code":"1601418","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601418","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Knee Support Large","code_information":[{"code":"1601371","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601371","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Knee Support Medium","code_information":[{"code":"1601370","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601370","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Mouth To Mouth Resuscitat","code_information":[{"code":"1601270","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601270","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Neowrap Occlusive","code_information":[{"code":"1601906","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601906","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Patella Strap","code_information":[{"code":"1601375","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601375","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Phaseal Protecor 28","code_information":[{"code":"1600717","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600717","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Phaseal Protector 14","code_information":[{"code":"1600718","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600718","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Skin Stapler 35w","code_information":[{"code":"1600818","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600818","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Sodium Chl 2000 Irr","code_information":[{"code":"1600830","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Splint Colles Wrist Sm Rt","code_information":[{"code":"1601421","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601421","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Stent Contour Vl 7fr","code_information":[{"code":"1600864","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600864","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Surfit Natura Pouch 2 1/4","code_information":[{"code":"1601539","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601539","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture Monocryl+ 4-0","code_information":[{"code":"1600940","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:ethilon 4-0 #662g","code_information":[{"code":"1600993","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:pds Iii 4-0 P3","code_information":[{"code":"1601012","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:prolene 3-0 #8687h","code_information":[{"code":"1601032","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:prolene 4-0 8682g","code_information":[{"code":"1601038","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:prolene 4-0 8699g","code_information":[{"code":"1601039","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture:vicryl 4-0 J284 G","code_information":[{"code":"1601100","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Tennis Elbow Support","code_information":[{"code":"1601522","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601522","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Thermometer Oral","code_information":[{"code":"1601322","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601322","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Universal Arm Immobil Lg","code_information":[{"code":"1601189","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601189","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Universal Arm Immobil Sm","code_information":[{"code":"1601191","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601191","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Vicryl Plus Ct-1 Vcp261h","code_information":[{"code":"1602123","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602123","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":23,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":14}]}]},{"description":"Suture Ethilon 3-0","code_information":[{"code":"1601639","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601639","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Airway Adult Ovassapian","code_information":[{"code":"1600033","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Anti-reflux Valve","code_information":[{"code":"1600047","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Arm Immobilizer Med Unive","code_information":[{"code":"1601404","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601404","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"C-collara Foam Small Reg","code_information":[{"code":"1601416","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601416","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Clavicle Brace Xlg Padded","code_information":[{"code":"1601414","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601414","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Colles Wrist Splint L Lg","code_information":[{"code":"1600262","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600262","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Colles Wrist Splint L Med","code_information":[{"code":"1600263","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600263","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Colles Wrist Splint L Sm","code_information":[{"code":"1600264","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600264","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Colles Wrist Splint R Med","code_information":[{"code":"1600265","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600265","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Dressing Aquacel Pro Foam Sacral 8 X 7","code_information":[{"code":"1601849","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601849","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Endo Tube Introducer, Bougie Adult","code_information":[{"code":"1601794","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601794","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Evacuated Container 1000","code_information":[{"code":"1601358","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601358","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Finger Cot Brush-curette","code_information":[{"code":"1602091","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602091","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Knee Sleeve Open Large","code_information":[{"code":"1601367","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601367","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Knee Sleeve Open Med","code_information":[{"code":"1601366","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601366","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Knee Sleeve Open Small","code_information":[{"code":"1601365","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601365","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Metatarsal Pad Med","code_information":[{"code":"1600615","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600615","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Metatarsal Pad Small","code_information":[{"code":"1601497","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601497","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Nasopharyngeal Airway 28","code_information":[{"code":"1600636","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600636","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Peep Valve, W/adapter, Disp","code_information":[{"code":"1601850","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601850","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Phaseal Protector 50","code_information":[{"code":"1600719","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600719","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Raney Scalp Clip","code_information":[{"code":"1601907","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601907","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Rectal Themometer","code_information":[{"code":"1600754","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"90656 Quadrivalent Influenza Vacc. Inact. 6 Mos Up[chas]","code_information":[{"code":"20090686","type":"CDM"},{"code":"636","type":"RC"},{"code":"90686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Injection, Dexamethosone Sodium Phosphate Charge","code_information":[{"code":"200J110010","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Duloxetine 30 Mg [Chas]","code_information":[{"code":"CP17640152376476470","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687073401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lidocaine Topical 2% Gel10 Ml Syringe [Chas]","code_information":[{"code":"CP17640152376505232","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":22,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Gram Stain Pspc Add On Charge","code_information":[{"code":"35087205G","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Body Fluid Amylase Pspc","code_information":[{"code":"35082150P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Debridement, Open Wound, Per Session; First 20 Sq Cm Or Less","code_information":[{"code":"14097597","type":"CDM"},{"code":"510","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Catheter Foley 22fr 30cc","code_information":[{"code":"1601293","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601293","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Catheter Foley 24fr 30cc","code_information":[{"code":"1601294","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601294","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Kangaroo Pump & Flush St","code_information":[{"code":"1601277","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601277","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Ltx Foley Cath 30cc 16fr","code_information":[{"code":"1600578","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Ltx Foley Cath 30cc 20fr","code_information":[{"code":"1600580","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600580","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Phaseal Injuector Luer Lo","code_information":[{"code":"1600716","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600716","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Sterile Water Irri/2000ml","code_information":[{"code":"1600876","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600876","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Sutrue Monocryl Undyed 0 Ct-1 36â","code_information":[{"code":"1601903","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601903","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Suture Chromic 5-0 P3","code_information":[{"code":"1601821","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601821","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Suture Ethilon 3-0 Psl","code_information":[{"code":"1600931","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Suture Vicryl 5-0 P53 J5006","code_information":[{"code":"1601617","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601617","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Suture:ethilon 4-0 Ps-2","code_information":[{"code":"1600996","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600996","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Suture:vicryl 5-0 #J493g","code_information":[{"code":"1601102","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Ekg 12 Lead, Interp/report Only Charge.","code_information":[{"code":"20093010","type":"CDM"},{"code":"521","type":"RC"},{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"99212 School Physical","code_information":[{"code":"200SCHOOL","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP200SCHOOL","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}]},{"description":"Hydrocortisone Topical 2.5%30 Gm Cre[chas]","code_information":[{"code":"CP17640152376482164","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168008031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Valacyclovir 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376557461","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237004230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":21,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":13}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Kid Stone Eval Add On Charge 14","code_information":[{"code":"35084295P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Kid Stone Eval Add On Charge 16","code_information":[{"code":"35084520P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Kid Stone Eval Add On Charge 4","code_information":[{"code":"35082310P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Kid Stone Eval Add On Charge 6","code_information":[{"code":"35082435P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Urine Cystine Pspc (Kse Addon)","code_information":[{"code":"35082131P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Urinalysis test","code_information":[{"code":"35081003P","type":"CDM"},{"code":"301","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Cath Foley 22fr 5cc 3-way","code_information":[{"code":"1601493","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601493","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Cath. Foley Silastic 18fr","code_information":[{"code":"1600181","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Clavicle Strap Padded Lg","code_information":[{"code":"1600230","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Esophageal Stethoscope 18","code_information":[{"code":"1601377","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601377","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Knee Sleeve Open Xl","code_information":[{"code":"1601368","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601368","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Limb Isolator Stockin Sm","code_information":[{"code":"1601381","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601381","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Oxygen Mask Open Pediatri","code_information":[{"code":"1600680","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600680","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Pca Pump Tubing","code_information":[{"code":"1601471","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601471","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Post Op Shoe Ladies Med","code_information":[{"code":"1600735","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Post-op Shoe Ladies Sm","code_information":[{"code":"1601451","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601451","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Post-op Shoe Mens Medium","code_information":[{"code":"1601452","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601452","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Skin Stapler  5 Shot","code_information":[{"code":"1600817","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600817","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Slick Set Cuffed 8.0","code_information":[{"code":"1601311","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601311","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Suture Ethilon 3-0 Ps-2 1669h","code_information":[{"code":"1602064","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Suture Vicryl 6-0 P-3","code_information":[{"code":"1601394","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601394","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Suture:vicryl 4-0 #J494g","code_information":[{"code":"1601097","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Tamponade 9cm W/balloons","code_information":[{"code":"1601551","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601551","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":20,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":12}]}]},{"description":"Environmental Culture","code_information":[{"code":"35087070V","type":"CDM"},{"code":"306","type":"RC"},{"code":"CP35087070V","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Charge â Physical Therapy Student Billing Ptsb","code_information":[{"code":"310PTSB","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Barrier W/tape 2 3/4 Flng","code_information":[{"code":"1601844","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601844","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"C-collar Foam Narrow Smal","code_information":[{"code":"1601473","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601473","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Central Temp Probe 9ft","code_information":[{"code":"1601467","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601467","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Continu-flu W/regulator","code_information":[{"code":"1600280","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Dome Paste (Unnaboot)","code_information":[{"code":"1600318","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600318","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Et Tube  Holder Pediatari","code_information":[{"code":"1601310","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601310","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Extension Set W/filter","code_information":[{"code":"1600846","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600846","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Nipple Shield 16mm Xsmall","code_information":[{"code":"1601744","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601744","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Nipple Shield 20mm Small","code_information":[{"code":"1601745","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601745","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Splashcap Wound Irrigation","code_information":[{"code":"1601775","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601775","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Surgez Stockinette Lg","code_information":[{"code":"1600918","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600918","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture Ethibond 1 Ctx","code_information":[{"code":"1601393","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601393","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture Vicryl 4-0 Ps-2","code_information":[{"code":"1600956","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600956","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture3 Monocryl4.0sh 41s","code_information":[{"code":"1601109","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture:chromic 0 #904h","code_information":[{"code":"1600960","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600960","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture:ethilon 5-0 #698g","code_information":[{"code":"1600998","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture:ethilon 6-0 #1698g","code_information":[{"code":"1600999","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Wafer Barrier Flat Skin W/ Flange 2 1/4","code_information":[{"code":"1601880","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"90656influenza Virus Vacc, Trivalent (Iiv3), Split Virus, Pf, Im","code_information":[{"code":"20090656","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":19,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Diclofenac Topical 1% Gel [Chas]","code_information":[{"code":"CP17640152376477899","type":"CDM"},{"code":"250","type":"RC"},{"code":"00067815202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Basic metabolic panel","code_information":[{"code":"35080048P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"35085025P","type":"CDM"},{"code":"301","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"11721-debride Nale 6 Or More-sc Tech","code_information":[{"code":"14011721","type":"CDM"},{"code":"510","type":"RC"},{"code":"11721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Dressing Bike Pressure Lg","code_information":[{"code":"1601498","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601498","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Oxygen Mask Open Adult","code_information":[{"code":"1600679","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600679","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Suture Ethilon 6-0 Ps-3","code_information":[{"code":"1601408","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601408","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}]},{"description":"Acetaminophen-hydrocodone 325 Mg-7.5 Mg/15 Ml Sol[chas]","code_information":[{"code":"CP17640152376434560","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687041744","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Oxycodone Cr 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376526846","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolpidem 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376561545","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093007301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":18,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"11056-trim Skin Lesions 2 To 4 -Sc Tech","code_information":[{"code":"14011056","type":"CDM"},{"code":"510","type":"RC"},{"code":"11056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Arm Sling Lg","code_information":[{"code":"1600054","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Arm Sling Med","code_information":[{"code":"1600055","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Arm Sling Sm","code_information":[{"code":"1600056","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Arm Sling X-lg","code_information":[{"code":"1601402","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601402","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Bld Press Cuff #3 Neonata","code_information":[{"code":"CP17640151597104962","type":"CDM"},{"code":"CP17640151597104962","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Bandage Esmark 4x12'","code_information":[{"code":"1600068","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600068","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Et Tube Holder Adult","code_information":[{"code":"1600382","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600382","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Scotchcast Splnt 2 X10","code_information":[{"code":"1600790","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600790","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Suture:chromic 3-0 #G122h","code_information":[{"code":"1600970","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600970","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"J2920 Methylprednisolone Sod Suc 40mg Vial [Chas]","code_information":[{"code":"200J2920","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Clarithromycin 500 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376468259","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862022660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lidocaine Topical 5% Oint [Chas]","code_information":[{"code":"CP17640152376504911","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462041820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Artificial Tears 3.5 Gm Oint[chas]","code_information":[{"code":"CP17640152376443975","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":17,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}],"drug_information":{"unit":35,"type":"GR"}},{"description":"Colchicine 0.6 Mg Tab[chas]","code_information":[{"code":"CP17640152376460275","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904712004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Blood test, clotting time","code_information":[{"code":"35085610P","type":"CDM"},{"code":"301","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Electrode Cautery Blade 6.5","code_information":[{"code":"1601676","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601676","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"69209 Removal Impacted Cerumen Using Irrigation/lavage, Unilateral","code_information":[{"code":"14069209","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Bubble Humidifier High Fl","code_information":[{"code":"1600119","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600119","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Catheter Coude 14fr","code_information":[{"code":"1601335","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601335","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Catheter Coude Tip 16fr","code_information":[{"code":"1601399","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601399","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Catheter Coude Tip 18fr","code_information":[{"code":"1601400","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601400","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Catheter Coude Tip 20fr","code_information":[{"code":"1601334","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601334","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Catheter Coude Tip 24fr","code_information":[{"code":"1601333","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601333","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Cord Disp Bipolar Forceps","code_information":[{"code":"1602050","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Dressing Aquacel Sacral 8 X 7","code_information":[{"code":"1601848","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601848","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Dressing Bike Pressure","code_information":[{"code":"1600327","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600327","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Spiral Electrode","code_information":[{"code":"1600844","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600844","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Sponges Tonsil Medium","code_information":[{"code":"1601383","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601383","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Suture Prolen 4-0 Rb1","code_information":[{"code":"1600945","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600945","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Flu Vaccine Split 6-35 Months Im Poc","code_information":[{"code":"20090657","type":"CDM"},{"code":"521","type":"RC"},{"code":"90657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}]},{"description":"Sucralfate 1 G/10 Ml Sus","code_information":[{"code":"CP17640152376553131","type":"CDM"},{"code":"250","type":"RC"},{"code":"82182010614","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":16,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":10}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Cefuroxime 250 Mg Tab[chas]","code_information":[{"code":"CP17640152376457325","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Celecoxib 100 Mg Cap Ud [Chas]","code_information":[{"code":"CP17640152376453122","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268016815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clopidogrel 75 Mg Tab[chas]","code_information":[{"code":"CP17640152376463153","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904629461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Escitalopram 10 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376474265","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904642661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lidocaine Topical 2%  Oral Solud [Chas]","code_information":[{"code":"CP17640152376500943","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121095003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nebivolol 5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376522619","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651013830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nitrofurantoin 50 Mg Cap[chas]","code_information":[{"code":"CP17640152376523083","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268062315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pantoprazole 40 Mg Oral Ec Tab[chas]","code_information":[{"code":"CP17640152376531555","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268063915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tranexamic Acid 650 Mg Tab [Chas]","code_information":[{"code":"CP17640152376554961","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918030130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Valsartan 80 Mg Tab[chas]","code_information":[{"code":"CP17640152376558099","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Allergen , Qual Pspc","code_information":[{"code":"35086005QLP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Allergen, Quant Pspc","code_information":[{"code":"35086003QTP","type":"CDM"},{"code":"312","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Aspergillus, Qual Pspc","code_information":[{"code":"35086606P","type":"CDM"},{"code":"302","type":"RC"},{"code":"86606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Immunodiffusion Ab,pspc","code_information":[{"code":"35086331IDP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Bulb Reservoirs 100cc","code_information":[{"code":"1601644","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601644","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"15 Micron Filter 41 Inch Tubing","code_information":[{"code":"1602118","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Catheter Foley 14fr 5cc","code_information":[{"code":"1601285","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601285","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Catheter Foley 22fr 5cc","code_information":[{"code":"1601295","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601295","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Dressing Allevyn  4x4","code_information":[{"code":"1600325","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600325","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Esmark Bandage 6","code_information":[{"code":"1600377","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600377","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Ltx Foley Cath 3cc 10fr","code_information":[{"code":"1600583","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600583","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Ltx Foley Cath 5cc  24fr","code_information":[{"code":"1600587","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600587","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Ltx Foley Cath 5cc 12fr","code_information":[{"code":"1600588","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600588","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Ltx Foley Cath 5cc 16fr","code_information":[{"code":"1600589","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600589","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Ltx Foley Cath 5cc 8fr","code_information":[{"code":"1600591","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600591","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Needle Spinal 20 X 3.5","code_information":[{"code":"1601474","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601474","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Nu Gauze Iodoform 2","code_information":[{"code":"1601347","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601347","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Pca Set Epidural Yellow","code_information":[{"code":"1601526","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601526","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Spinal Needle 18 X 3.5","code_information":[{"code":"1600836","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Sponges Tonsil Small","code_information":[{"code":"1601384","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601384","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Sterile Sleeve","code_information":[{"code":"1600868","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600868","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Surefit Pouch  2.25","code_information":[{"code":"1600910","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600910","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Nylon 5-0 C-2 10","code_information":[{"code":"1601615","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601615","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Pds Ii 0 Ct-1 27in Vi Z340h","code_information":[{"code":"1602065","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Prolene 4-0 Fs-2 8683g","code_information":[{"code":"1601724","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601724","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Tegaderm Dressing 4x61/2","code_information":[{"code":"1601130","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601130","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Wound Drain Collect 4 X 8","code_information":[{"code":"1601262","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601262","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Injection, Darbepoetin Alfa, 1 Microgram (For Esrd On Dialysis)","code_information":[{"code":"200J0882","type":"CDM"},{"code":"521","type":"RC"},{"code":"J0882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Amoxicillin  400 Mg/5 Ml Bottle[chas]","code_information":[{"code":"CP17640152376444265","type":"CDM"},{"code":"250","type":"RC"},{"code":"81964020751","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":15,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Electrode Cautery Blade 2.5","code_information":[{"code":"1601675","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601675","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Monocryl 0","code_information":[{"code":"1601632","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601632","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"51798us Urine Capacity Measuresc Tech","code_information":[{"code":"14051798","type":"CDM"},{"code":"510","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"0.9% Sod Chl Irr Uro 1000","code_information":[{"code":"1600000","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Aspira Luer Adapter","code_information":[{"code":"1602079","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602079","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Cath Kit 12fr Closed System","code_information":[{"code":"1602085","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602085","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Needle Tuohy 18g X 3.5","code_information":[{"code":"1601892","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601892","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Sterile Water Irruromatic","code_information":[{"code":"1600877","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600877","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Stoma Wafer 4x4 1 1/2 Fla","code_information":[{"code":"1601357","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601357","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Stylet, Intubating 14fr","code_information":[{"code":"1601338","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601338","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Nylon 4-0 C-2 10","code_information":[{"code":"1601616","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Suture Prolene 2-0-fs","code_information":[{"code":"1600947","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600947","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Universal Cath Kit","code_information":[{"code":"1601193","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601193","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"90685 Quadrivalent, Pediatric  6 To 35 Months","code_information":[{"code":"20090685","type":"CDM"},{"code":"521","type":"RC"},{"code":"90685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Hydroxyzine 25mg","code_information":[{"code":"200J3410","type":"CDM"},{"code":"521","type":"RC"},{"code":"J3410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Injection Nalbuphine Hydrochloride","code_information":[{"code":"200J2300","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}]},{"description":"Acyclovir 400 Mg Tab [Chas]","code_information":[{"code":"CP17640152376434484","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine 25 Mg Tab[chas]","code_information":[{"code":"CP17640152376543391","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687032701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Venlafaxine 37.5 Mg Er [Chas]","code_information":[{"code":"CP17640152376567633","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Lidocaine Topical 5% Fil[chas]","code_information":[{"code":"CP17640152376503847","type":"CDM"},{"code":"250","type":"RC"},{"code":"00603188016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":14,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Chas Iv Contrast 100 Ml","code_information":[{"code":"365Q9967100","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Chas Iv Contrast 75 Ml","code_information":[{"code":"365Q996775","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Armboard Pad Foam 7 1/2x16x2","code_information":[{"code":"1602067","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Cannula Hiflo 14' Adult","code_information":[{"code":"1600144","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Cath Iv Jelco 14ga 1 1/4","code_information":[{"code":"1601787","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601787","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Cautery Pad","code_information":[{"code":"1600196","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1600196","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Cord Clamp Sterile","code_information":[{"code":"1601260","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601260","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Delta-lite Pl  Tape 4 L/blue","code_information":[{"code":"1601989","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Filter Syringe 5 Micron 32mm","code_information":[{"code":"1602025","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Iv Cath Jelco 16 Ga","code_information":[{"code":"1600524","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Limb Isol. Stocking Large","code_information":[{"code":"1600568","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600568","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Stocking Embolism Knee 3x-large","code_information":[{"code":"1602027","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Suture Vicryl Plus  0  Ur-6 Antibacterial","code_information":[{"code":"1602033","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"J3420 Vitamin B-12 (Cyanocobalamin)1000 Mcg [Chas]","code_information":[{"code":"200J3420","type":"CDM"},{"code":"521","type":"RC"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}]},{"description":"Menthol Topical 4% Gel [Chas]","code_information":[{"code":"CP17640152376503360","type":"CDM"},{"code":"250","type":"RC"},{"code":"59316010212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Cholestyramine 4 Gm Pkt Ud [Chas]","code_information":[{"code":"CP17640152376450998","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":13,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":8}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Allergen Specific Ige, Quantitative","code_information":[{"code":"35086003EA","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Body Fluid Ld Pspc","code_information":[{"code":"35083615P","type":"CDM"},{"code":"301","type":"RC"},{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Gamma Gt Pspc","code_information":[{"code":"35082977P","type":"CDM"},{"code":"301","type":"RC"},{"code":"82977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Hf Blood Type Abo","code_information":[{"code":"35086900HF","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Hf Rh Type","code_information":[{"code":"35086901HF","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"11055 Pairing Or Cutting Of Benign Hyperkeratotic Lesion; Single Lesion","code_information":[{"code":"14011055","type":"CDM"},{"code":"510","type":"RC"},{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Chas Iv Contrast 50 Ml","code_information":[{"code":"365Q996750","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Alginate Dressing Dermaginate 4x4","code_information":[{"code":"1602114","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"17003 Destruction Benign/premalig 2-14 Lesions, Each Charge","code_information":[{"code":"20017003","type":"CDM"},{"code":"521","type":"RC"},{"code":"17003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Bacitracin/poly B 500-10000 Units/gm Oint[chas]","code_information":[{"code":"CP17640152376443106","type":"CDM"},{"code":"250","type":"RC"},{"code":"00501379801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}],"drug_information":{"unit":500,"type":"UN"}},{"description":"Meloxicam 7.5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376500936","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268052515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":12,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Allergen Specific Ige (Arup) Pspc","code_information":[{"code":"35086003RP","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 1","code_information":[{"code":"35084437PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"84437","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 10","code_information":[{"code":"35082657PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 12","code_information":[{"code":"35082726PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"82726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 2","code_information":[{"code":"35082261PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"82261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 3","code_information":[{"code":"35082776PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"82776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 4","code_information":[{"code":"35083789PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 5","code_information":[{"code":"35083498PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 6","code_information":[{"code":"35083516PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 7","code_information":[{"code":"35082760PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"82760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 8","code_information":[{"code":"35081479PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Newborn Screen Add On Charge 9","code_information":[{"code":"35083020PE","type":"CDM"},{"code":"300","type":"RC"},{"code":"83020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Suture Prolene 3-0","code_information":[{"code":"1601634","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601634","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"11720-debride Nale 1-5 -Sc Tech","code_information":[{"code":"14011720","type":"CDM"},{"code":"510","type":"RC"},{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"92504-binocular Micrscopy Sep Dx Proc-sc Tech","code_information":[{"code":"14092504","type":"CDM"},{"code":"510","type":"RC"},{"code":"92504","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Biopsy Punch 2.0 Mm","code_information":[{"code":"1601279","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601279","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Nu Gauze Plain 2","code_information":[{"code":"1601345","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601345","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Peanut Sponges 10/ Pk","code_information":[{"code":"1600702","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600702","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Pediatric Electrodes","code_information":[{"code":"1600704","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600704","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Pouch Carry For Elastomeric Pump","code_information":[{"code":"1602024","type":"CDM"},{"code":"CP1602024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Skn Stapler Remvr","code_information":[{"code":"1600819","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600819","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Sod Chl Irr 1500 Cc","code_information":[{"code":"1600829","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600829","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Sterile Water/irr 1500cc","code_information":[{"code":"1600880","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Surgex Stockinette Med","code_information":[{"code":"1600916","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600916","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Suture Pds Ii 3-0 Z416h","code_information":[{"code":"1600942","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600942","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Suture Prolene 2-0 Ct2 8411h","code_information":[{"code":"1601621","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601621","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Suture Silk 3-0 Sh K832h","code_information":[{"code":"1601859","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601859","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Suture:prolene 1-0 #8425h","code_information":[{"code":"1601027","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Toomey Syringe","code_information":[{"code":"1601154","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601154","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Urinary Drain Bag","code_information":[{"code":"1601211","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}]},{"description":"Paroxetine 20 Mg Tab[chas]","code_information":[{"code":"CP17640152376530591","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904567761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":11,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ast Pspc (Kse Addon)","code_information":[{"code":"35084450P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Bili Total Pspc (Kse Addon)","code_information":[{"code":"35082247P","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Kidney function panel test","code_information":[{"code":"35080069P","type":"CDM"},{"code":"301","type":"RC"},{"code":"80069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Uric Acid Pspc (Kse Addon)","code_information":[{"code":"35084550P","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"08290-3065-13heparin Flush Soln [Chas]","code_information":[{"code":"1651333","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"63807-0100-10sodium Chloride 0.9% Sol 10ml Syringe [Chas]","code_information":[{"code":"1651461","type":"CDM"},{"code":"258","type":"RC"},{"code":"A4216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"11045- Deb Subq Tissue Add-onsc Tech","code_information":[{"code":"14011045","type":"CDM"},{"code":"510","type":"RC"},{"code":"11045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Chas Non-heu Tc-99m","code_information":[{"code":"370Q9969","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Biopsy Punch 3.5 Mm","code_information":[{"code":"1601281","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"C-arm Drape 42in X 64in","code_information":[{"code":"1601915","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601915","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Calf-high Stocking  Lg","code_information":[{"code":"1600134","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Calf-high Stocking  Xlg","code_information":[{"code":"1600135","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Cannula, Dual Nasal, Co2 Monit, O2 Del","code_information":[{"code":"1601702","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601702","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Cath Kit 10fr Closed System","code_information":[{"code":"1602084","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602084","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Disposable Wash Cloths","code_information":[{"code":"1600317","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600317","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Embolism Knee Stockings S","code_information":[{"code":"1600358","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600358","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Extension Set Y-type","code_information":[{"code":"1601315","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601315","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Leg Bag","code_information":[{"code":"1600599","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600599","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Mastisol Adhesive","code_information":[{"code":"1600600","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600600","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Needle Spinal 22 X 5","code_information":[{"code":"1601475","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601475","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Sponges Tonsil Large","code_information":[{"code":"1601382","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601382","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Stocking Embolism Knee  M","code_information":[{"code":"1600884","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600884","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Stylette Sm Adult/child","code_information":[{"code":"1601317","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601317","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Ethicon 2-0 Fs1 18in","code_information":[{"code":"1602088","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602088","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl 4-0 Fs-2","code_information":[{"code":"1601390","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601390","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 0 #Ur6","code_information":[{"code":"1601077","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 3-0 #J205g","code_information":[{"code":"1601086","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601086","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Syringe  7cc","code_information":[{"code":"1601111","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Tube Naso-gastric 8fr","code_information":[{"code":"1601484","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601484","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Urethral Cath Tray 16fr","code_information":[{"code":"1601209","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601209","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Wound Irrigation Shield","code_information":[{"code":"1601252","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601252","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Diazepam Injection 5 Mg Charge","code_information":[{"code":"200J3360","type":"CDM"},{"code":"521","type":"RC"},{"code":"J3360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Mirtazapine 30 Mg Tab[chas]","code_information":[{"code":"CP17640152376511157","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107000334","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Citalopram 20 Mg Tab [Chas]","code_information":[{"code":"CP17640152376464796","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Polyethylene Glycol 3350 238 Gm Bottle Prep [Chas]","code_information":[{"code":"CP17640152376532307","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896048914","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":3350,"type":"GR"}},{"description":"Heparin 100 Units/ml5ml Syringe[chas]","code_information":[{"code":"CP17640152376489589","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Heel/ankle Protector","code_information":[{"code":"1601638","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601638","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Monocryl 3-0","code_information":[{"code":"1601633","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601633","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl Plus 1-0","code_information":[{"code":"1601640","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601640","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Airway Nasopharyngeal 34f","code_information":[{"code":"1601515","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Basic Soln Set (Chemo)","code_information":[{"code":"1601469","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601469","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"C-arm Drape 72in X 42in","code_information":[{"code":"1601913","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601913","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Casting Tape 3 Pink","code_information":[{"code":"1601445","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601445","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Cath Flocath Caude 12fr","code_information":[{"code":"1600166","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600166","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Connector/syr Fml To Fml Luer Lock","code_information":[{"code":"CP17640151597114893","type":"CDM"},{"code":"CP17640151597114893","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Delta Lite Plus Tape 3 Red","code_information":[{"code":"1601592","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601592","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Delta-lite Pl  Tape 3 C","code_information":[{"code":"1601446","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601446","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Dilator Cervical","code_information":[{"code":"1601626","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601626","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Floraseptic Wound Gel","code_information":[{"code":"1602104","type":"CDM"},{"code":"636","type":"RC"},{"code":"A6248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Gauze Packing/iodofor .5","code_information":[{"code":"1600436","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600436","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Gauze Packing/iodofor 1","code_information":[{"code":"1600437","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600437","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Incentive Spirometer Adul","code_information":[{"code":"1600497","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600497","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Nasopharyngeal Airway  30","code_information":[{"code":"1600634","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600634","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Nasopharyngeal Airway 26","code_information":[{"code":"1600635","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600635","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Phaseal Infusion Adapter","code_information":[{"code":"1600715","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600715","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Stomahesive Paste 2 Oz","code_information":[{"code":"1601316","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601316","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Stylette Adult 10fr","code_information":[{"code":"1600896","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600896","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Ethibond 3-0 Rb-1","code_information":[{"code":"1601305","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601305","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicry+anibac 2-0 Vcp417h","code_information":[{"code":"1601784","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601784","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl 3-0 Mh","code_information":[{"code":"1601392","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601392","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl 3-0 Rb-1","code_information":[{"code":"1600954","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl 3-0 Sh","code_information":[{"code":"1600955","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:ethilon 5-0 #661g","code_information":[{"code":"1600997","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 0 #J287g","code_information":[{"code":"1601073","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 0 #J946h","code_information":[{"code":"1601076","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 4-0 #J315h","code_information":[{"code":"1601093","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601093","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 4-0 #J415h","code_information":[{"code":"1601094","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601094","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture:vicryl 5-0 J213h","code_information":[{"code":"1601104","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601104","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Suture Vicryl 3-0 Ct-2","code_information":[{"code":"1600953","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Tape Cast Deltlite 2purp","code_information":[{"code":"1601531","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601531","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Tube Stomach 16fr","code_information":[{"code":"1601314","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601314","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Vesta-syde Packets","code_information":[{"code":"1601237","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601237","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Water Sterile Inhalation Soln 1000ml","code_information":[{"code":"1601959","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Injection, Promethazine Hcl, Up To 50 Mg Charge","code_information":[{"code":"200J2550","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"J1100 Dexamthasone 4 Mg Sdv [Chas]","code_information":[{"code":"200J1100","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}]},{"description":"Amoxicillin/pot Clavulanate 875 Mg-125 Mg  Tab[chas]","code_information":[{"code":"CP17640152376446889","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093227534","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Calamine/zinc Oxide 113 Gm Oint[chas]","code_information":[{"code":"CP17640152376452311","type":"CDM"},{"code":"250","type":"RC"},{"code":"00799000104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":113,"type":"GR"}},{"description":"Metolazone 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376518584","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888005301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bandage Coban Lf 6 Sterile","code_information":[{"code":"1601682","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601682","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Amnihook","code_information":[{"code":"1600035","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Biopsy Punch 3.0 Mm","code_information":[{"code":"1601280","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Biopsy Punch 6mm","code_information":[{"code":"1601353","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601353","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cast Tape Colored 2","code_information":[{"code":"1600157","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600157","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cath Flocath Caude 14fr","code_information":[{"code":"1600167","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600167","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cath Flocath Coude 16fr","code_information":[{"code":"1601504","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cath Kit Pediatric 8fr","code_information":[{"code":"1602083","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602083","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Deltalite Plus Tape 2 Red","code_information":[{"code":"1601591","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601591","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Dressing Duoderm Cgf","code_information":[{"code":"1600330","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600330","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Gauze Packing Plain  1","code_information":[{"code":"1600433","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600433","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Introcan Cath 18 Ga X1.25","code_information":[{"code":"1600515","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Introcan Cath 20 Ga","code_information":[{"code":"1600516","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600516","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Introcan Cath 22 Ga X 1","code_information":[{"code":"1600517","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600517","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Introcan Cath 24ga X .75in","code_information":[{"code":"1601795","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601795","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Needle Spinal Ped 22 X1.5","code_information":[{"code":"1601478","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601478","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Scotchcast Tape Fiber 2","code_information":[{"code":"1600794","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600794","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Sodium Chlor Irr 1000ml","code_information":[{"code":"1600832","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600832","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Sterile Water/irr 1000cc","code_information":[{"code":"1600879","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Stylette Pedi / Neonatal","code_information":[{"code":"1601312","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Surefit Stoma Wafer 1 1/2","code_information":[{"code":"1601355","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601355","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Suture Vicryl 2-0 J317h","code_information":[{"code":"1601391","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601391","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Suture Vicryl 3-0 Sh J316h","code_information":[{"code":"1601389","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601389","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Suture:vicryl 2-0 #Ct1","code_information":[{"code":"1601080","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Tracheostomy Care Kit","code_information":[{"code":"1601323","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601323","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"J1200 Diphenhydramine 50mg Sdv [Chas]","code_information":[{"code":"200J1200","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Pregabalin 75 Mg Oral Capsule[chas]","code_information":[{"code":"CP17640152376534397","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687049501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Biopsy Punch 4.0 Mm","code_information":[{"code":"1601282","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601282","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Biopsy Punch 5.0 Mm","code_information":[{"code":"1601283","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601283","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Bld Press Cuff #4 Neonata","code_information":[{"code":"CP17640151597106718","type":"CDM"},{"code":"CP17640151597106718","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Bp Cuff Neonatal Disp #5","code_information":[{"code":"CP17640151597104300","type":"CDM"},{"code":"CP17640151597104300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cath Kit Female","code_information":[{"code":"1601596","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601596","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Cath Kit Pedi 5fr","code_information":[{"code":"1601481","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601481","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Disposable Scalpel  #11","code_information":[{"code":"1600314","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600314","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Disposable Scalpel  #15","code_information":[{"code":"1600315","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600315","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Extension Set 6","code_information":[{"code":"1600389","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600389","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Gas Sampling Line","code_information":[{"code":"1601387","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601387","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Gauze Packing-plain .25","code_information":[{"code":"1600439","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600439","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Gauze Packing/plain .5","code_information":[{"code":"1600438","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600438","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Ice Pack  Lg","code_information":[{"code":"1600495","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Ice Pack  Sm","code_information":[{"code":"1600496","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Kangaroo Proximal Spike","code_information":[{"code":"1601298","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601298","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Nu Gauze Iodoform 1/4","code_information":[{"code":"1601346","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601346","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Phasela Connector Luer Lo","code_information":[{"code":"1600720","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600720","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Pouch Clamp","code_information":[{"code":"1601313","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601313","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Salem Sump Tube 12fr","code_information":[{"code":"1600780","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600780","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Scalpel W/#10 Blade","code_information":[{"code":"1601268","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601268","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Sodium Chloride  500ml","code_information":[{"code":"1600833","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Sterile Water/irr  500cc","code_information":[{"code":"1600878","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Suture Silk 0 Ct-1","code_information":[{"code":"1601576","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601576","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Tube Salem Sump 18fr","code_information":[{"code":"1601309","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601309","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Injection, Morphine Sulfate, Up To 10 Mg.","code_information":[{"code":"200J2270","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}]},{"description":"Bacitracin Ointment 500u/gm28 Gm[chas]","code_information":[{"code":"CP17640152376444280","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":500,"type":"GR"}},{"description":"Miconazole Topical 2% Cre15 Gm[chas]","code_information":[{"code":"CP17640152376511830","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672200101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Morphine Sulf Er 15 Mg Tab[chas]","code_information":[{"code":"CP17640152376519233","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904655761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Bupropion Sr 150 Mg Tab[chas]","code_information":[{"code":"CP17640152376459193","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598075260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Enalapril 10 Mg Tab Ud[chas]","code_information":[{"code":"CP17640152376474302","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547054710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nitroglycerin 0.2 Mg/hr Patch[chas]","code_information":[{"code":"CP17640152376520200","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378910493","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Triamcinolone Topical 0.1%  15 Gm Cre[chas]","code_information":[{"code":"CP17640152376551580","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Artificial Tears Drops[chas]","code_information":[{"code":"CP17640152376447018","type":"CDM"},{"code":"250","type":"RC"},{"code":"10119002003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azithromycin 250 Mg Tab[chas]","code_information":[{"code":"CP17640152376440297","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687074265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Lorazepam 2 Mg/ml Oral Conc1 Ml [Chas]","code_information":[{"code":"CP17640152376509588","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":5}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ramipril 2.5 Mg Cap[chas]","code_information":[{"code":"CP17640152376540840","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862047501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hot/cold Pack","code_information":[{"code":"1601649","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601649","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Anesthesia Ext Set 30","code_information":[{"code":"1601468","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601468","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Bubble Oxygen Humidifier","code_information":[{"code":"1600120","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Cast Plaster Bandg 5","code_information":[{"code":"1601411","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601411","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Nr Mask Pediatric","code_information":[{"code":"1600667","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600667","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Oxygen Cannula Infant","code_information":[{"code":"1600676","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600676","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Peri-rectal Dressing  Avg","code_information":[{"code":"1600712","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600712","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Plastalume Splnt Ba4.25","code_information":[{"code":"1600725","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600725","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Polymem Cloth Strips 1inx 3in","code_information":[{"code":"1601868","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601868","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Tendon Finger Splint","code_information":[{"code":"1601436","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601436","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Vaseline Gauze 1/2 X 72","code_information":[{"code":"1601397","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601397","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"J1885 Ketorolac 30 Mg Sdv [Chas]","code_information":[{"code":"200J1885","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}]},{"description":"Tizanidine 4 Mg Tab[chas]","code_information":[{"code":"CP17640152376551980","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904641861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Amlodipine 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376441493","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904637061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Captopril 12.5 Mg Tab[chas]","code_information":[{"code":"CP17640152376455835","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687030421","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Digoxin 0.125 Mg Tab[chas]","code_information":[{"code":"CP17640152376472114","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904592161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Mineral Oil 100% Liq10 Ml[chas]","code_information":[{"code":"CP17640152376514437","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Nystatin 100 Mu/ml5 Ml Cup[chas]","code_information":[{"code":"CP17640152376525366","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121086840","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Codeine/acetaminophen 30-300 Mg Tab[chas]","code_information":[{"code":"CP17640152376469706","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diazepam 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376461257","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diphenhydramine Cream 30 Gm [Chas]","code_information":[{"code":"CP17640152376470301","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Fluconazole 100 Mg Tab[chas]","code_information":[{"code":"CP17640152376488835","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904650006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Guaifenesin/codeine 100-10 Mg/5 Ml Syrup 1ml[chas]","code_information":[{"code":"CP17640152376481943","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121077504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydrocodone/acetaminophen 5-325 Mg Tab[chas]","code_information":[{"code":"CP17640152376480586","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Isosorbide Mono 30 Mg  Er Tab[chas]","code_information":[{"code":"CP17640152376490909","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Methylprednisolone 4 Mg Tab [Chas]","code_information":[{"code":"CP17640152376511240","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806040021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Midazolam Syrup 2mg/ml [Chas]","code_information":[{"code":"CP17640152376518499","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574015004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Oxycodone 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376524847","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406055262","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pregabalin 50 Mg Oral Capsule[chas]","code_information":[{"code":"CP17640152376535355","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904699261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tramadol 50 Mg Tab[chas]","code_information":[{"code":"CP17640152376558164","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904749661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Urea 15 Gm Packet [Chas]","code_information":[{"code":"CP17640152376550249","type":"CDM"},{"code":"250","type":"RC"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Organism Id, Anaerobe Pspc","code_information":[{"code":"35087076P","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Bandage Coban Lf 4 Sterile","code_information":[{"code":"1601683","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601683","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Dressing Medipore+pad","code_information":[{"code":"1601636","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601636","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Braun Adapter Luer Lock","code_information":[{"code":"1601813","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601813","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Cast Plaster Bandg 4","code_information":[{"code":"1601410","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601410","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Cast Plaster J & J 3","code_information":[{"code":"1600154","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600154","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Cath Foley Silastic 16fr","code_information":[{"code":"1600171","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600171","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Elastic Bandage  6","code_information":[{"code":"1600342","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600342","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Eye Protector, Convex","code_information":[{"code":"1601273","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601273","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Feeding Tube 8fr X 15","code_information":[{"code":"1601275","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601275","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Flolink Iv Access Device","code_information":[{"code":"1600419","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600419","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Heparin Lock Adaptor","code_information":[{"code":"1600480","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600480","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Hot Pack Dispos. Instant","code_information":[{"code":"1601359","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601359","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Irr Tray W/piston Syringe","code_information":[{"code":"1600521","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600521","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Lap Sponges 5/pk","code_information":[{"code":"1600553","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600553","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Ltx Foley Cath 30cc 14fr","code_information":[{"code":"1600577","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600577","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Oxygen Trach Mask Adult","code_information":[{"code":"1600685","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600685","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Penrose Tubing Drain 1/4","code_information":[{"code":"1600707","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600707","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Salem Sump Tube  14fr","code_information":[{"code":"1600777","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600777","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Salem Sump Tube 10fr","code_information":[{"code":"1600779","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600779","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Salem Sump Tube 16fr","code_information":[{"code":"1600781","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600781","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Spinal Needle 25 X 3.5","code_information":[{"code":"1600841","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Ball  6 1/4","code_information":[{"code":"1601437","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601437","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Ball 7 1/4","code_information":[{"code":"1601438","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601438","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Plain 2 1/4","code_information":[{"code":"1601449","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601449","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Tray Bulb Syringe Irr","code_information":[{"code":"1601265","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601265","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Umbilical Tape","code_information":[{"code":"1601356","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601356","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Vaseline Lip Therapy","code_information":[{"code":"1601224","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601224","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Hydromorphone Injection","code_information":[{"code":"200J1170","type":"CDM"},{"code":"521","type":"RC"},{"code":"J1170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"J2060 Lorazepam 2 Mg/1 Ml [Chas]","code_information":[{"code":"200J2060","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Alprazolam 0.25 Mg Dis Tab [Chas]","code_information":[{"code":"CP17640152376440929","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Glucose 40% Gel [Chas]","code_information":[{"code":"CP17640152376489558","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574006930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Prochlorperazine 5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376536642","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904738106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Divalproex Sodium 125 Mg Dr Cap [Chas]","code_information":[{"code":"CP17640152376477545","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Phenylephrine Nasal 0.5% Spr15 Ml[chas]","code_information":[{"code":"CP17640152376532008","type":"CDM"},{"code":"250","type":"RC"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Gabapentin 300 Mg Cap[chas]","code_information":[{"code":"CP17640152376483155","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Buprenorphine 2 Mg Sl Tab [Chas]","code_information":[{"code":"CP17640152376454452","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904715404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lidocaine Topical 2% Gel5 Ml [Chas]","code_information":[{"code":"CP17640152376502470","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Magnesium Citrate Soln 1.745 Gm/300 Ml Bottle[chas]","code_information":[{"code":"CP17640152376503691","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1745,"type":"GR"}},{"description":"Morphine 20 Mg/ml Oral Conc1 Ml[chas]","code_information":[{"code":"CP17640152376514479","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406800315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nifedipine 10 Mg Gcap[chas]","code_information":[{"code":"CP17640152376528596","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904722961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nifedipine Er 30 Mg Tab[chas]","code_information":[{"code":"CP17640152376525184","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Silver Sulfadiazine Top 1%25 Gm Crm[chas]","code_information":[{"code":"CP17640152376548026","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"17478-0711-10lidocaine Topical 2% Gel5 Ml [Chas]","code_information":[{"code":"1651294-GY","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS","modifier":"GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GY"],"minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"43553-3249-13aloe Vesta 2 In 1 Protective 3 Ointment, 60 Gm [Chas]","code_information":[{"code":"1651575-GY","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS","modifier":"GY"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GY"],"minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"G0127-trim Dystropic Nails Any Number-sc Tech","code_information":[{"code":"140G0127","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Trimming Of Nails","code_information":[{"code":"14011719","type":"CDM"},{"code":"510","type":"RC"},{"code":"11719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Artificial Nose","code_information":[{"code":"1601466","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601466","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Cast Plaster J & J 2","code_information":[{"code":"1600153","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Catheter Urethral 8fr","code_information":[{"code":"1601329","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601329","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Cold Pack Instant","code_information":[{"code":"1600261","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600261","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Connector Microclave","code_information":[{"code":"1600279","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600279","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Ear Wick Sterile","code_information":[{"code":"1601288","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Elastic Bandage 4","code_information":[{"code":"1600344","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600344","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Finger Splnt Thimble 2","code_information":[{"code":"1600412","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600412","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Nebulizer Mask & Tubing","code_information":[{"code":"1600640","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600640","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Nursing Pads","code_information":[{"code":"1601306","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601306","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Oxygen Cannula Pediatric","code_information":[{"code":"1600677","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600677","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Oxygen Specialty Mask","code_information":[{"code":"1600683","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600683","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Plastalume Splnt Ba5.25","code_information":[{"code":"1600726","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600726","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Respiratory Bacteria Filt","code_information":[{"code":"1601284","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601284","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Ballend 3.2","code_information":[{"code":"1601434","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601434","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Thimb 3 1/2","code_information":[{"code":"1601447","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601447","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Splint Finger Tip Large","code_information":[{"code":"1601448","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601448","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Steristrip .5","code_information":[{"code":"1600883","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Stomach Tube  18fr","code_information":[{"code":"1600891","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600891","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Suture Vicryl 0 Ct Vcp958","code_information":[{"code":"1601930","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601930","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}]},{"description":"Bumetanide 1 Mg Tab [Chas]","code_information":[{"code":"CP17640152376445213","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904701606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cephalexin 500 Mg Cap[chas]","code_information":[{"code":"CP17640152376458666","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268015215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Colestipol 1 Gm Tab[chas]","code_information":[{"code":"CP17640152376465497","type":"CDM"},{"code":"250","type":"RC"},{"code":"00115521116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dexamethasone 4 Mg Tab[chas]","code_information":[{"code":"CP17640152376464614","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904726661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Doxycycline Monohydrate 100 Mg Cap [Chas]","code_information":[{"code":"CP17640152376478686","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268028115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ondansetron 4 Mg Odt [Chas]","code_information":[{"code":"CP17640152376528942","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237007710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ondansetron 4 Mg/5 Ml Oral Sol [Chas]","code_information":[{"code":"CP17640152376527190","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ondansetron 8 Mg Odt [Chas]","code_information":[{"code":"CP17640152376526370","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862039110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Pyridostigmine 60 Mg Tab [Chas]","code_information":[{"code":"CP17640152376545328","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382065906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lactulose 10 G/15 Ml Soln [Chas]","code_information":[{"code":"CP17640152376499293","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963043864","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Sodium Chloride Nasal 0.65% Gel14.1 Gm[chas]","code_information":[{"code":"CP17640152376546128","type":"CDM"},{"code":"250","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":3}]}],"drug_information":{"unit":65,"type":"GR"}},{"description":"Midodrine 5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376511110","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268056215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chas Mri Iv Contrast 15","code_information":[{"code":"375A957715","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Aerosol Mask Pediatric","code_information":[{"code":"1600022","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Alcohol Isopropyl 70% 4 Oz","code_information":[{"code":"1602046","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602046","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Drain Penrose 1/2 X 12","code_information":[{"code":"1601308","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601308","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Dressing Medipose+pad 3.5x6","code_information":[{"code":"1601622","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601622","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Elastic Bandage 3","code_information":[{"code":"1600343","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600343","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Enema  Ss","code_information":[{"code":"1600374","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600374","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Feeding Tube Infant  5fr","code_information":[{"code":"1600408","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600408","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Finger Splnt Thimble1.5","code_information":[{"code":"1600413","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600413","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Needle Holder (Counter)","code_information":[{"code":"1601696","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601696","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Oxygen Mask Pediatric","code_information":[{"code":"1601304","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601304","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Splint Finger Plain  3.25","code_information":[{"code":"1601431","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601431","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Tegaderm Dressing 4x4 3/4","code_information":[{"code":"1601131","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Tube Stomach/levin 12fr","code_information":[{"code":"1601336","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601336","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Wafer Sur Auto Lock 2 3/4","code_information":[{"code":"1601319","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601319","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"J2765 Metoclopramide 10mg/2ml Sdv [Chas]","code_information":[{"code":"200J2765","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Allopurinol 100 Mg Tab[chas]","code_information":[{"code":"CP17640152376431513","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amiodarone 200 Mg Tab[chas]","code_information":[{"code":"CP17640152376446819","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904699361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Amitriptyline 25 Mg Tab[chas]","code_information":[{"code":"CP17640152376449566","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268003815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amoxicillin 250 Mg Cap [Chas]","code_information":[{"code":"CP17640152376443452","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ampicillin 500 Mg Cap [Chas]","code_information":[{"code":"CP17640152376441926","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781214501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Atenolol 25 Mg Tab[chas]","code_information":[{"code":"CP17640152376444570","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904718761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atorvastatin 20 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376440212","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904629106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Atorvastatin 40 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376445995","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904629206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Baclofen 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376444230","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904647561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Balmex Diaper Rash Cream 60g (Zinc Oxide) [Chas]","code_information":[{"code":"CP17640152376444505","type":"CDM"},{"code":"250","type":"RC"},{"code":"38137002423","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Benazepril 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376443071","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268011015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Benzonatate 100 Mg Cap[chas]","code_information":[{"code":"CP17640152376445099","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904715361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Buspirone 15 Mg Tab [Chas]","code_information":[{"code":"CP17640152376455479","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268013515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Carbidopa/levodopa 25-100mg Tab[chas]","code_information":[{"code":"CP17640152376450007","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904750161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Carvedilol 12.5 Mg Tab[chas]","code_information":[{"code":"CP17640152376454630","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904730761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Carvedilol 6.25 Mg Tab[chas]","code_information":[{"code":"CP17640152376458028","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904730661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Cephalexin 250 Mg Cap [Chas]","code_information":[{"code":"CP17640152376453507","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268015115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ciprofloxacin 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376451787","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904724361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clindamycin 150 Mg Cap[chas]","code_information":[{"code":"CP17640152376460542","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904595961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clonazepam 0.5 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376462064","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651072201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonidine 0.1 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376468064","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268019215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyclobenzaprine 5 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376467223","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904740006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dicyclomine 10 Mg Cap[chas]","code_information":[{"code":"CP17640152376472703","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem 60 Mg Tab[chas]","code_information":[{"code":"CP17640152376470228","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687072801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Diltiazem Cd 120 Mg Cap[chas]","code_information":[{"code":"CP17640152376475879","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Divalproex 250 Mg Tab Er[chas]","code_information":[{"code":"CP17640152376477662","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268025915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Donepezil 10 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376475467","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904647861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Famotidine 20 Mg Tab[chas]","code_information":[{"code":"CP17640152376472895","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268029915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine 10 Mg Cap Ud [Chas]","code_information":[{"code":"CP17640152376482964","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904734561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Folic Acid 1 Mg Tab[chas]","code_information":[{"code":"CP17640152376480432","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904722461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Furosemide 20 Mg Tab[chas]","code_information":[{"code":"CP17640152376485918","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904717761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Furosemide 40 Mg Tab[chas]","code_information":[{"code":"CP17640152376484019","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054829925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gabapentin 100 Mg Cap[chas]","code_information":[{"code":"CP17640152376482123","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Glipizide 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376480285","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268036115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydrochlorothiazide 25mg Tab[chas]","code_information":[{"code":"CP17640152376486275","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrochlorothiazide-triamterene 25 Mg-37.5 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376484930","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084075025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroxyzine Pam 25mg Cap[chas]","code_information":[{"code":"CP17640152376498713","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268039850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hyoscyamine 0.125 Mg Dis Tab [Chas]","code_information":[{"code":"CP17640152376498353","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ibuprofen 800 Mg Tab[chas]","code_information":[{"code":"CP17640152376492097","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904585561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Indomethacin 25 Mg Cap[chas]","code_information":[{"code":"CP17640152376492757","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Labetalol 100 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376493363","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lactobacillus Acidophiluscap Ud [Chas]","code_information":[{"code":"CP17640152376492990","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333000450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiracetam 500 Mg Tab [Chas]","code_information":[{"code":"CP17640152376505991","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904712461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levothyroxine 50mcg Tab[chas]","code_information":[{"code":"CP17640152376507434","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687046401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Levothyroxine 75 Mcg (0.075 Mg) Tab Ud [Chas]","code_information":[{"code":"CP17640152376508679","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904695161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Lisinopril 10 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376509791","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904679861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Loperamide 2 Mg Cap[chas]","code_information":[{"code":"CP17640152376500206","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268048215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam 0.5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376503408","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093342501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Losartan 50 Mg Tab[chas]","code_information":[{"code":"CP17640152376502666","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268050515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Meclizine 25 Mg Tab[chas]","code_information":[{"code":"CP17640152376506188","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268052315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Memantine 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376505981","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904650606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metformin 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376509329","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904716261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin Er  500 Mg Tab [Chas]","code_information":[{"code":"CP17640152376508239","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268055015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metoclopramide 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376519110","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metoprolol  Succinate 25 Mg Er  Ud Tab [Chas]","code_information":[{"code":"CP17640152376519988","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904632206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metoprolol Tartrate 25 Mg Tab[chas]","code_information":[{"code":"CP17640152376518056","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metoprolol Tartrate 50 Mg Tab [Chas]","code_information":[{"code":"CP17640152376518996","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079080120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metronidazole 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376512571","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268053515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Miconazole Topical 2% Powder 45 Gm [Chas]","code_information":[{"code":"CP17640152376518219","type":"CDM"},{"code":"250","type":"RC"},{"code":"00316022515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Misoprostol 100 Mcg Tab[chas]","code_information":[{"code":"CP17640152376510874","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954044310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Montelukast 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376516842","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904680806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Multivitamin With Minerals Tab  [Chas]","code_information":[{"code":"CP17640152376517681","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536344508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitroglycerin 0.4 Mg Tab[chas]","code_information":[{"code":"CP17640152376525704","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598043611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Omeprazole 20 Mg Cap[chas]","code_information":[{"code":"CP17640152376529340","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904691761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxybutynin 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376528536","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832003801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenazopyridine 99.5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376537933","type":"CDM"},{"code":"250","type":"RC"},{"code":"49973024412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":995,"type":"ME"}},{"description":"Phenytoin 100 Mg Er Cap [Chas]","code_information":[{"code":"CP17640152376530978","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Potassium Bicarbonate 10 Meq Eff Tab [Chas]","code_information":[{"code":"CP17640152376533443","type":"CDM"},{"code":"250","type":"RC"},{"code":"51801001330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Potassium Chl-sodium Chl 30 Mg-450 Mg Tab [Chas]","code_information":[{"code":"CP17640152376538969","type":"CDM"},{"code":"250","type":"RC"},{"code":"38485086335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Potassium Chloride 10 Meq Er Tab[chas]","code_information":[{"code":"CP17640152376537542","type":"CDM"},{"code":"250","type":"RC"},{"code":"00245531701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pramipexole 0.5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376530115","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687058121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prednisolone Sodium Phosphate 1 Mg/1 Ml Oral Liqmd [Chas]","code_information":[{"code":"CP17640152376532288","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925016604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Prednisone 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376539626","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904692361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prednisone 5 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376538172","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Promethazine 6.25 Mg/5 Ml Oral Syrup [Chas]","code_information":[{"code":"CP17640152376530434","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121092716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Propranolol 40 Mg Tab[chas]","code_information":[{"code":"CP17640152376543692","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268066415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Risperidone 1 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376549960","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904736261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sertraline 50 Mg Tab[chas]","code_information":[{"code":"CP17640152376541903","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sodium Bicarbonate 650 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376540307","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904726161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Sodium Chloride 3% Inh Sol15ml [Chas]","code_information":[{"code":"CP17640152376545245","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Spironolactone 50 Mg Tab[chas]","code_information":[{"code":"CP17640152376557929","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687047601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sulfamethoxazole-trimethoprim 200 Mg-40 Mg/5 Ml Oral Susp [Chas]","code_information":[{"code":"CP17640152376559125","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121085416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sulfamethoxazole-trimethoprim 800 Mg-160 Mg Tab[chas]","code_information":[{"code":"CP17640152376556430","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904272561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sulfasalazine 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376557456","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tamsulosin 0.4 Mg Cap [Chas]","code_information":[{"code":"CP17640152376554113","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904738361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Torsemide 20 Mg Tab[chas]","code_information":[{"code":"CP17640152376553290","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904728306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Trazodone 50 Mg Tab[chas]","code_information":[{"code":"CP17640152376559141","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Warfarin 1 Mg Tab[chas]","code_information":[{"code":"CP17640152376562277","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Warfarin 2 Mg Tab[chas]","code_information":[{"code":"CP17640152376564937","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Warfarin 3 Mg Tab[chas]","code_information":[{"code":"CP17640152376569895","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Warfarin 4 Mg Tab[chas]","code_information":[{"code":"CP17640152376560147","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Warfarin 5 Mg Tab[chas]","code_information":[{"code":"CP17640152376566698","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832121601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zinc 50 Mg Tab [Chas]","code_information":[{"code":"CP17640152376566250","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295013588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nicotine 14 Mg Patch[chas]","code_information":[{"code":"CP17640152376524426","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536589553","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Nicotine 21 Mg Patch[chas]","code_information":[{"code":"CP17640152376527043","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000051201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Oxymetazoline Nasal 0.05% Spr [Chas]","code_information":[{"code":"CP17640152376538874","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sodium Chloride Nasal 0.65% Spr45 Ml[chas]","code_information":[{"code":"CP17640152376552413","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":65,"type":"ML"}},{"description":"17003-destruct Premalg Les 2-14-tech","code_information":[{"code":"14017003","type":"CDM"},{"code":"510","type":"RC"},{"code":"17003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Chas Mri Iv Contrast 20","code_information":[{"code":"375A957720","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Aquacel Extra 4x5 Dressing","code_information":[{"code":"1601935","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601935","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Asepto Syringe","code_information":[{"code":"1600059","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Bandage Conforming 6 Ste","code_information":[{"code":"1601352","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601352","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Cath Plug","code_information":[{"code":"1600179","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600179","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Cath-n-glove Kit 14fr","code_information":[{"code":"1601278","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601278","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Catheter Suction 12fr","code_information":[{"code":"1601485","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Catheter Urethral 10fr","code_information":[{"code":"1601324","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601324","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Catheter Urethral 12fr","code_information":[{"code":"1601325","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601325","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Catheter Urethral Robnel 14fr","code_information":[{"code":"1602032","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Cision Gauze  1x8","code_information":[{"code":"1600227","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Disposable Towel Fenestra","code_information":[{"code":"1600316","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600316","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Drain Pouch 2 3/4 Auolok","code_information":[{"code":"1601318","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601318","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Drain Sponge  4x4","code_information":[{"code":"1600322","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600322","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Dressing Adaptic  3x3","code_information":[{"code":"1600324","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600324","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Elastic Bandage  2","code_information":[{"code":"1600341","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600341","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Eye Pads Small Oval","code_information":[{"code":"1601272","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601272","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Gauze Sponges  2/ Pkg","code_information":[{"code":"1600440","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600440","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Gauze Sponges 10/ Pkg","code_information":[{"code":"1600441","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Hydrogen Peroxide 3% 4 Oz","code_information":[{"code":"1602047","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1602047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Iv Dressing","code_information":[{"code":"1600526","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600526","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Kerlix Roll","code_information":[{"code":"1600534","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600534","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Male Ext Cath","code_information":[{"code":"1600596","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600596","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Oxygen Connecting Tube","code_information":[{"code":"1600678","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1600678","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Sponges 2 X 2 Sterile","code_information":[{"code":"1601483","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601483","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Sponges 3 X 3 Sterile","code_information":[{"code":"1601878","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Sterile Surgipad","code_information":[{"code":"1600872","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600872","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Sterile Telfa Pad  3x4","code_information":[{"code":"1600873","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Sterile Telfa Pad 2x3","code_information":[{"code":"1600874","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600874","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Steristrip .125","code_information":[{"code":"1600881","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600881","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Steristrip .25","code_information":[{"code":"1600882","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600882","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Stopcock 3-way","code_information":[{"code":"1600894","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1600894","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Stopcock 4-way","code_information":[{"code":"1601517","type":"CDM"},{"code":"271","type":"RC"},{"code":"CP1601517","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Tegaderm Dressi 13/4x13/4","code_information":[{"code":"1601321","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Telfa Pad Sterile 3x8","code_information":[{"code":"1601135","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Urethral Cath  14fr","code_information":[{"code":"1601203","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601203","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Urethral Cath  16fr","code_information":[{"code":"1601204","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601204","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Urological Filters-5","code_information":[{"code":"1601215","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601215","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Vaseline 1 Oz","code_information":[{"code":"1601221","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP1601221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Vaseline Gauze 3 X 18","code_information":[{"code":"1601330","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601330","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Vaseline Gauze 3 X 9","code_information":[{"code":"1601261","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601261","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Xeroform Gauze  5x9","code_information":[{"code":"1601256","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Xeroform Gauze 1x8","code_information":[{"code":"1601257","type":"CDM"},{"code":"272","type":"RC"},{"code":"CP1601257","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}]},{"description":"Polyethylene Glycol 3350 Oral Pwdr For Recon[chas]","code_information":[{"code":"CP17640152376534018","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904693126","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":3350,"type":"EA"}},{"description":"Acetaminophen 120 Mg Supp[chas]","code_information":[{"code":"CP17640152376431237","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Acetaminophen 160 Mg/5 Ml[chas]","code_information":[{"code":"CP17640152376432862","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094023162","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Acetaminophen 325 Mg Supp[chas]","code_information":[{"code":"CP17640152376436638","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Acetaminophen 325 Mg Tab[chas]","code_information":[{"code":"CP17640152376437471","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904677361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Acetaminophen 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376437653","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904673061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetaminophen 650 Mg Supp[chas]","code_information":[{"code":"CP17640152376438599","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Ascorbic Acid 500 Mg Tab[chas]","code_information":[{"code":"CP17640152376444628","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Aspirin  325 Mg Tab[chas]","code_information":[{"code":"CP17640152376449509","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896092101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Aspirin 81 Mg Chew Tab[chas]","code_information":[{"code":"CP17640152376441917","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896091136","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Bisacodyl 10 Mg Supp [Chas]","code_information":[{"code":"CP17640152376446178","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904714212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bisacodyl 5 Mg Tab [Chas]","code_information":[{"code":"CP17640152376446549","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904640761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bismuth Subsalicylate Susp [Chas]","code_information":[{"code":"CP17640152376446364","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000003202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Carb/vita D 600-400 Tab[chas]","code_information":[{"code":"CP17640152376459395","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268015015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Calcium Carbonate 500 Mg Chew Tab[chas]","code_information":[{"code":"CP17640152376450391","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904641292","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cholecalciferol 1000 Intl Units Oral Tablet[chas]","code_information":[{"code":"CP17640152376457340","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555003300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1000,"type":"UN"}},{"description":"Cholecalciferol 125 Mcg (5,000 Iu) Tab Ud [Chas]","code_information":[{"code":"CP17640152376458944","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268086615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":125,"type":"F2"}},{"description":"Cyanocobalamin 1000 Mcg Tab [Chas]","code_information":[{"code":"CP17640152376461150","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268085515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Dextromethorphan 30mg/5ml1 Ml Oral Susp[chas]","code_information":[{"code":"CP17640152376467928","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824017563","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diphenhydramine 12.5 Mg/5 Ml Cup[chas]","code_information":[{"code":"CP17640152376477107","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904698520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Diphenhydramine 25 Mg Cap[chas]","code_information":[{"code":"CP17640152376472316","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904723761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Docusate Sodium 100mg Cap[chas]","code_information":[{"code":"CP17640152376476430","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904718361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Docusate-senna 50 Mg-8.6 Mg Tab[chas]","code_information":[{"code":"CP17640152376473310","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ferrous Sulfate 325 Mg Tab[chas]","code_information":[{"code":"CP17640152376471865","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904759161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Fish Oil 1000 Mg Cap[chas]","code_information":[{"code":"CP17640152376480342","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333030810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Glucose 3.75 G Chew Tab [Chas]","code_information":[{"code":"CP17640152376484455","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151161111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Glycerin Adult Supp[chas]","code_information":[{"code":"CP17640152376482494","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980041012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glycerin Pediatric Supp[chas]","code_information":[{"code":"CP17640152376484854","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000042901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Guaifenesin 20 Mg/ml5 Ml [Chas]","code_information":[{"code":"CP17640152376484739","type":"CDM"},{"code":"250","type":"RC"},{"code":"61787051404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Guaifenesin 600 Mg Tab[chas]","code_information":[{"code":"CP17640152376488550","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084057201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Ibuprofen 100 Mg/5 Ml Sus Ud [Chas]","code_information":[{"code":"CP17640152376490298","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094049462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ibuprofen 200 Mg Tab[chas]","code_information":[{"code":"CP17640152376499101","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904791461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lactulose 20 Gm/30 Ml Cup[chas]","code_information":[{"code":"CP17640152376492140","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121115440","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Loratadine 10 Mg Tab[chas]","code_information":[{"code":"CP17640152376508441","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268048915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Loratadine 5 Mg/5 Ml Elixir[chas]","code_information":[{"code":"CP17640152376507621","type":"CDM"},{"code":"250","type":"RC"},{"code":"54838055840","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Magnesium Hydrox/al Hydrox/sim 30 Ml Cup[chas]","code_information":[{"code":"CP17640152376506611","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Magnesium Hydroxide 400 Mg/5 Ml30 Ml Cup[chas]","code_information":[{"code":"CP17640152376501924","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896064916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Magnesium Oxide 400 Mg Tab[chas]","code_information":[{"code":"CP17640152376507774","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980033901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Melatonin 5 Mg Tab Ud [Chas]","code_information":[{"code":"CP17640152376500939","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555003900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Multivitamin Tab[chas]","code_information":[{"code":"CP17640152376519627","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904053961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multivitamin W/ Minerals Tab Ud [Chas]","code_information":[{"code":"CP17640152376517871","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333086110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naproxen Sodium 220 Mg Tab [Chas]","code_information":[{"code":"CP17640152376520261","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536109306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":220,"type":"ME"}},{"description":"Psyllium 3.4 G/12 G Oral Pwdr[chas]","code_information":[{"code":"CP17640152376549081","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":34,"type":"GR"}},{"description":"Simethicone 20 Mg/0.3 Ml Oral Sus [Chas]","code_information":[{"code":"CP17640152376547523","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Simethicone 80 Mg Chew Tab[chas]","code_information":[{"code":"CP17640152376547148","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333081210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Sodium Biphosphate-sodium Phosphate 19 G-7 G Rectal Enema 135 Ml[chas]","code_information":[{"code":"CP17640152376549384","type":"CDM"},{"code":"250","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":19,"type":"GR"}},{"description":"Vitamin B1 100 Mg Tab [Chas]","code_information":[{"code":"CP17640152376563899","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333093410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"J2405 Ondansetron 4 Mg Sdv [Chas]","code_information":[{"code":"200J2405","type":"CDM"},{"code":"521","type":"RC"},{"code":"J2405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Midlands Choice","plan_name":"Medicare Advantage","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}]}]},{"description":"Chargept Travel Ptt","code_information":[{"code":"310PTT","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","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}]}]},{"description":"Chargephysical Therapist Assistant Pta45","code_information":[{"code":"310PTA45","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","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}]}]},{"description":"Chargephysical Therapist Pt60","code_information":[{"code":"310PT60","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Ambetter","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield Nebraska","plan_name":"Network Blue","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}]}]}],"last_updated_on":"2025-12-02","location_name":["Chase County Hospital"],"hospital_address":["600 W 12th Street PO Box 819,  Imperial, NE 69033"],"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":"Mel McNea"},"type_2_npi":["1609934843"],"license_information":{"state":"NE"},"version":"3.0.0"}